Center Based Screener

Center Based Screener

Child MUST be between 10 to 18 years of age.(Required)

PREREQUISITE FOR PROGRAM ADMISSION: Child MUST have the following foundational skills for the group intervention to be impactful.

Click yes or no to questions below.
Follow group rules in a classroom setting (minimum of 4-step instruction)(Required)
Remain calm when experiencing undesired outcomes (no physical aggression and/or vocal outbursts)(Required)
Must be able to remain seated & compliant at a table in a group therapy class setting for a minimum duration of 15-20 mins at a time(Required)
Ability to verbally communicate wants & needs to peer(s) and group facilitators in appropriate manner(Required)
Ability to answer questions with minimum of 4–5 word sentence response(Required)

Does your child/student need additional support to do the following things below:

Developing/maintaining friendships, interpreting body language and social cues of others, managing and self-regulating emotions of others, developing self-advocacy skills, and developing self confidence.
(Required)
Has your child participated in a Social Skills group previously?(Required)
If yes, please select other private service received:
Select all that apply
How did you hear about our program?

Contact Information

Name(Required)
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Disclaimer

This is not a guarantee of services. This form is utilized as an initial screening process for staff purposes only. If it is determined that your child may be a potential fit for this program, a member of our staff will reach out to schedule a secondary in-person screening.