Watch Me Thrive Program Application

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Watch Me Thrive is an innovative and customized, 16 week employment readiness program that supports the individual and their family in gaining the skills they need to make the transition from school based programs a successful one.

Email *

Child's Name

Child's Date of Birth

YYYY

Parent's Name *

Parent's Phone Number *

Individual's Developmental Diagnosis

School District

Does your child receive funding through state? *

Autism Project (Autism Waiver)

Sarah Lopez Waiver

Partners for Hope Waiver

Comprehensive Waiver

No, my child does not currently receive funding from the state

Will you be applying for a scholarship or private pay? *

Scholarship

Private Pay

Other:

Please Describe Your Child Including How they Communicate. *

Does your child need assistance with personal hygiene such as toileting? *

Yes

Partial / Requires Support

Does your child require physical assistance with mobility or other gross motor or fine motor tasks *

Yes

Does your child have behaviors such as tantrumming, self-injury, property destruction or aggression *

Does your child elope? *

Yes

Do you have safety concerns about your child when participating in group or community outings? *

What level of support does your child require *

1:1

1:2 - 1:3

1:4

What helps your child be successful? *

How does your child learn new skills best *

Visual

Auditory

Combination

Other:

What are your child's preferred activities, hobbies and interests? *

Does your child have employment goals? (examples would be places they have said they want to work) *

What are your goals for your child's future? *

How Confident Do You Feel in Your Ability to Assist Your Child in Obtaining and Maintaining Employment? *

Not Confident At All

Very Confident

Do You Feel You Would Benefit From Transition Planning Parent Mentoring to Assist you in Preparing for Your Child's Future? *

Yes

Maybe

What barriers do you feel your child will encounter in obtaining and maintaining employment? *

What areas do you feel your child could benefit from skill development (Check All That Apply)? *

Workplace Communication Skills such as Receiving Instructions and Accepting Feedback

Task initiation and Staying on Task, Time Management, Professional Behaviors,

Problem Solving, Decision Making, Planning Completion of Multi Step Tasks Sequential Tasks

Resume Writing, Interview Skills

Professionalism such as Workplace Social Skills, Hygiene and Grooming

Self Confidence and Self Advocacy

Job Specific Tasks

Other:

Required

Has Your Child Participated in any Work Based Learning Experiences such as Through Their School District Program or Volunteering? Please Describe in Detail. *

Does your child have strong dislikes?

What is the best way to redirect your child?

Please provide any additional information that you feel will help our staff support your child's success.

Send me a copy of my responses.

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