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 <br /> <br />12. Able to cross: _____2-way stop _____4-way stop? <br />_____YES _____NO _____SOMETIMES <br />________________________________________________________________________ <br />13. Able to cross traffic light-controlled intersection in the following areas: <br />____residential _____semi-business _____business <br />14. If you have a cognitive disability, are you able to give name, address, and telephone <br />numbers upon request? <br />_____YES _____NO _____SOMETIMES <br />________________________________________________________________________ <br />15. Are you able to recognize your destination or landmark? <br />_____YES _____NO _____SOMETIMES <br />________________________________________________________________________ <br />16. Deal with unexpected situations or unexpected changes in routine? <br />_____YES _____NO _____SOMETIMES <br />________________________________________________________________________ <br />17. Ask for, understand, and follow directions? <br />_____YES _____NO _____SOMETIMES <br />________________________________________________________________________ <br />18. Safely and effectively travel through crowded and/or complex facilities? <br />_____YES _____NO _____SOMETIMES <br />________________________________________________________________________ <br />27EXHIBIT 5 <br />ReturntoAgenda