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!
Parent's Full Name
Child's Full Name
Child's Date of Birth
Parent's Phone Number
Does your child have diagnosis? If so, please include
What services does your child currently receive?
No formal mode of communication
Alternative communication (PECs, Sign Language, Communication Device)
Requires 1:1 support always
Requires 1:1 support sometimes
Does not require 1:1 support
Requires minimal support
Not toilet trained
Aggression towards peers
Aggression towards adults
Elopement (leaving area without permission)
Tantrum ( screaming/flopping on the floor)
Loud vocal stereotopy
No problem behavior
If your child is currently in school, select placement type
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
Child's interests include
Child's dislikes include
Identify the top 3 skills you would like to learn in this Parent/Caregiver Training Group:
Identify the top 3 topics you would like to address in this Parent/Caregiver Training Group:
Do you have any additional questions you would like us to address?
Send me a copy of my responses.
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This form was created inside of Infinity ABA Therapy & Autism Services LLC.