PROJECT "PRAYAS" : A project initiated by Autism Society of India
Information related to the parents
Prayas-Reaching Out- Reinforcing Potentials
Father's Name
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Father's Occupation
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Mother's Name
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Mother's Occupation
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Address
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Mobile number of Mother and Father
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Landline number
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Email ID
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Have you previously applied to participate in project Prayas
Information related to the individual with Autism Spectrum Disorder
Student's Name
Your answer
Date of birth
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Diagnosis (Previous reports if any)
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Diagnosis from
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Medication (If any)
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School (History)
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Name some 'likes' and 'dislikes' of the student
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Name 4 strengths of the student
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Name 4 areas of improvement of the student
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Attention Span
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Challenging behavior (If any)
Your answer
Behavior protocol (If any)
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Older Students (10+)
Reading Ability
Your answer
Writing Ability
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Comprehension
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Spellings
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Younger Students
Alphabet Recognition
Your answer
Number Recognition
Your answer
Colours
Your answer
Shapes
Your answer
Communication
Mode of Communication
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Asks Verbally
Your answer
Able to show Gestures
Your answer
Computer and Assistive technology related information
Estimate your computer skill level
No Experience
Expert
Do you own a computer?
If you own a computer, then which one?
Do you use computer or assistive technology with the student?
If yes, what software/assistive technology does the student use?
Your answer
Does the student use computer at school?
Is the student independent while using the computer?
Your answer
Can the student use the mouse?
Your answer
What technology based tools you would like your child to learn?
Your answer
Describe some computer skills of the student (Typing speed, Function keys, Browsing etc. ) if he/she is using one
Your answer
Describe some iPad related skills of the student if he/she is using one
Your answer
By submitting this application you acknowledge that if accepted into project 'Prayas' you will attend the training sessions and work with the team for the benefit of the child.
Signature
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Date
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Please read the following and answer carefully
Signature
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Date
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