Skills Academy Application
Hello! Thank you in your interest in Infinity ABA Therapy & Autism Service's Skills Academy! The Skills Academy is designed for parents and caregivers in mind want to take a formal in-person class on ABA behavior strategies to help reduce their child's maladaptive behaviors while working on increasing functional, adaptive skills.. After receipt and review of this application, our team will contact you to discuss your family's needs and the next steps of the process. Thank you!
* Required
Email address
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Your email
Parent's Full Name
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Your answer
Child's Full Name
Your answer
Nickname
Your answer
Child's Age
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Your answer
Child's Gender
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Male
Female
Child's Date of Birth
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Your answer
Parent's Name
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Your answer
Parent's Phone Number
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Your answer
Does your child have diagnosis? If so, please include
Your answer
What services does your child currently receive?
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ABA therapy
Speech Therapy
Occupational Therapy
Feeding Therapy
Other
Communication
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No formal mode of communication
Alternative communication (PECs, Sign Language, Communication Device)
Single Word
Phrases
Sentences
Independence
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Requires 1:1 support always
Requires 1:1 support sometimes
Does not require 1:1 support
Toileting
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100% independence
Requires minimal support
Not toilet trained
Challenging Behaviors
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Self-Injury
Aggression towards peers
Aggression towards adults
Elopement (leaving area without permission)
Tantrum ( screaming/flopping on the floor)
Foul Language
Loud vocal stereotopy
No problem behavior
If your child is currently in school, select placement type
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Not in school for current term
In district self-contained
In district inclusion
In district other
In district general education
Out of district specialized school
Home School
Child's interests include
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Your answer
Child's dislikes include
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Your answer
Identify the top 3 skills you would like to learn in this Parent/Caregiver Training Group:
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Your answer
Identify the top 3 topics you would like to address in this Parent/Caregiver Training Group:
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Your answer
Do you have any additional questions you would like us to address?
Your answer
Send me a copy of my responses.
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