The transition process by which a student with moderate to severe disabilities is prepared to leave the school setting and enter into employment and community living is legally mandated and includes provisions for occupational therapy and other related services. This transition requires a team approach in which members collaborate to determine objectives with the student and his or her family in the domains of domestic, community, recreational, and vocational living. Assessment and intervention focus on functional activities that are chronologically age-appropriate and environmentally based. This focus on real life activities is a departure from the prereadiness skills and simulations used by some occupational therapists in school systems. This literature review describes the transition from school to community living, discusses methods to increase parental participation, and provides examples of functional assessments and intervention strategies pertinent to occupational therapy practice for persons with moderate to severe disabilities.