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!
Email address *
Parent's Full Name *
Your answer
Child's Full Name
Your answer
Nickname
Your answer
Child's Age *
Your answer
Child's Gender *
Child's Date of Birth *
Your answer
Parent's Name *
Your answer
Parent's Phone Number *
Your answer
Does your child have diagnosis? If so, please include
Your answer
What services does your child currently receive? *
Communication *
Independence *
Toileting *
Challenging Behaviors *
If your child is currently in school, select placement type *
Child's interests include *
Your answer
Child's dislikes include *
Your answer
Identify the top 3 skills you would like to learn in this Parent/Caregiver Training Group: *
Your answer
Identify the top 3 topics you would like to address in this Parent/Caregiver Training Group: *
Your answer
Do you have any additional questions you would like us to address?
Your answer
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