AAC Home Use Questionnaire
Child’s Name: _____________________________
Date:__________
Name(s) of people within the household (indicate ages and relationships):
Any special nicknames for the child or other family members:
Names of other close adult family, friends or extended family members (name and
relationship):
Names and types of pets:
Activities your child enjoys (think throughout the year):
Activities your child dislikes:
Created By Tarra Bailey Dec. 2009