Supported Independent Living (SIL) Assessment Form
Please complete this assessment to help determine suitability, support needs, daily living abilities, and accommodation preferences for Supported Independent Living.
Current Living Situation
*
With family
Group home
Living independently
Supported accommodation
Other
Level of Independence in Daily Activities
*
1
2
3
4
5
Support Needs Assessment
*
Rows
No Support Needed
Some Support Needed
Full Support Needed
Personal care
1
2
3
Meal preparation
4
5
6
Medication management
7
8
9
Household tasks
10
11
12
Communication Abilities
*
Verbal
Non-verbal
Uses communication aids
Other
Behavioral or Medical Support Needs
*
Behavioral support
Medical support
None
Other
Preferred Accommodation Type
*
Shared accommodation
Own unit within shared setting
Independent unit
No preference
Ability to Manage Personal Finances
*
1
2
3
4
5
Social Interaction Skills
*
Very limited
1
2
3
4
Excellent
5
1 is Very limited, 5 is Excellent
Readiness for Supported Independent Living
*
Ready
Requires further preparation
Not ready
Submit Assessment
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