Welcome to S2C @ GKTC Intake

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Email *

Speller's LAST Name *

Speller's FIRST name *

Speller's middle name *

Gender of Speller *

Male

Female

Prefer not to say

Required

Speller's Date of Birth *

YYYY

Street Address *

City *

State *

Zip Code/ Country Code *

Country *

Parents/Guardian's Name *

Phone Number *

What type of appointment are you looking to set up? *

Zoom Series (50 minutes each)

Local Assessment (1-2 hours in person, client and parents)

Intensive (4 sessions over two days, for nonlocal/out of town clients)

I'm not sure, and would like your recommendation

Filling out to participate in a GKTC Group

To better prepare for our time with you, please take a minute to tell us a bit about your speller. Likes, dislikes, communication style, services they have received and general results, any behaviors that would be helpful for us to be aware of ahead of time and anything more you think may be beneficial for us to know.

Also, do you have any experience using the letter boards to communicate? If so, please describe briefly.

A copy of your responses will be emailed to the address you provided.

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