Inhome Aba Program Intake Packet Page 12
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27Behavior Matters, LLC
Teaching Skills for Success
(253) 686-6958;
EDUCATION H ISTORY:
1. List i n c hronological o rder a ll s chools y ou c hild h as a ttended:
Name S ystem Y ear(s) G rade S pecial E d?
•
•
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2. Name(s) o f c urrent t eacher(s) _ _______________________________________
3. Does y our c hild’s t eacher h ave c oncerns a bout h im/her ( list) _ ______________
_________________________________________________________________
4. What i s y our c hild’s f avorite s ubject/class? _ ____________________________
5. What i s y our c hild’s l east p referred s ubject/class? _ ______________________
6. Has y our c hild e ver r epeated a g rade? Y /N I f y es, w hat g rade(s)?: _ __________
7. If y our c hild h as b een i n S pecial E ducation, d id t hey h ave a :
504 P lan
Occupational T herapy
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Evaluation
I.E.P.
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Physical T herapy E valuation
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Psychological E valuation
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Adaptive T echnology
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Special E valuation
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Evaluation
Behavior I ntervention P lan
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8. If y our c hild h as b een i n S pecial E ducation, h ow w ere t hey s erved?
Consultation
Resource C lassroom
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Collaborative E ducation
Team T aught C lasses
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Pull-‐Out
Self-‐Contained C lassroom
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Special P rogram
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Psycho e ducational C enter
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