Calling for Expressions of Interest for Professional Development

Your details

Name*

Parent or Primary Contact Name

Parent or Primary Contact Number*

Email address*

Parent or Primary Contact Email

Name of Teenager*

Age*

Please enter a number from 12 to 17.

Date of Birth*

What is the name of your child's Therapist - Type 'unsure' if you don't know their name.*

Location and Program Preferences

School Information

Name of School your child attends:*

What school year is your child currently in?*

Does your child have any other conditions/diagnoses? (e.g. Epilepsy, ADHD, Intellectual Disability)*

What School setting best describes your child's situation? Select from the drop down list below.*

Does your child complete mainstream curriculum at school or do they follow an adapted curriculum?*

Please describe any extra supports provided to your child in school i.e. education assistant, behaviour support plan, communication supports etc.

How would your describe your child's communication level? i.e. verbal, independent, requires communication support.*

Are there any issues or behaviours that may make it challenging for your child to be able to participate effectively in this type of group setting and duration? If yes, please describe.*

How would you describe your child's social skills?*

Does your child have an understanding of their own areas of need in terms of social skills learning?*

Is your child motivated to participate in a group to build on their social skills?.*

Do you have any concerns or queries in relation to this program?

Calling for Expressions of Interest for Professional Development

KONTAKT Teens - Expression of Interest

Your details

Location and Program Preferences

School Information