SNAP to Middle School Summer Application 2023
Thank you for your interest in our SNAP to Middle School program at Horizon Academy! This program is designed to kickstart student executive function (EF) readiness for students entering 6th and 7th grades in the 2023-2024 school year.

This program is designed to be small so please be advised that space is limited. Applications will be processed on a first-come, first-served basis. Review of your application will begin immediately. We may request additional information to be gathered from one of your student's teachers. However, please note that requests for additional information or clarifications does not immediately indicate a rejection of your application.

The program consists of eight hours of in-person, small-group, direct instruction in executive function strategies and 2 virtual follow-up meetings for students.

Sunday, July 30 / 3:00 - 4:00 p.m.
PARENTS are required to attend a virtual information session. (Parents Only)

Monday, July 31 - Thursday, August 3 / 9:00 -11:00 a.m. (Students Only)
Horizon Academy 
4901 Reinhardt Lane
Roeland Park, Kansas

Two virtual follow-up meetings for students (Students Only)
Sunday, September 24 / 3:00 - 4:00 p.m.
Sunday, October 29 / 3:00 - 4:00 p.m.   

The cost for this program is $550, paid in advance. 

The SNAP to Middle School program is designed to help forgetful, disorganized, and time-challenged students realize and embrace the new expectations of middle school. Students who benefit from this program are those who:
  • Can attend all in-person program sessions
  • Can attend all virtual follow-up sessions
  • Can work in small groups with peers
  • Can ask and answer questions in groups
  • Can be redirected when their attention shifts
  • Can transition away from a preferred activity
Students who require constant, individual adult support, or require a significant amount of movement or sensory stimulation to be productive, should explore our EF Coaching Program for individual students.

A staff member will contact you within three school days of receiving your application. 
 
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Parent's Email Address *
What grade will your student enter in August 2023? *
Where will your child attend school in the 2023-2024 School Year?
Student's Date of Birth *
MM
/
DD
/
YYYY
Describe your students academic needs *
Parent / Guardian Name (Last, First) *
Parent's Phone Number *
Describe your students social/emotional needs *
Student's Name  (Last, First) *
If known, please provide you student's counselor's name for the 2023-2024 School Year.
My Student *
Yes
Maybe
No
Takes ADHD medication
Requires a fidget
Resists writing
Is slow to warm
Is slow to trust
Please describe your student's strengths and interests *
Areas of Student Need

Please consider your student's behavior at school and while doing homework over the last 3 months and respond accordingly.

For each item, rate the SIZE of the problem considering both frequency and intensity. Don't overthink this, just go with your best guess.

  • XS/S is for problems that occur infrequently or that you consider not severe.
  • M/L is for problems that you have seen regularly from your student.
  • L/XL is for problems that you are most concerned about, even if they are in frequent

What additional information about your student would you like to share? *

PLANNING AHEAD, SEQUENCING STEPS

 *
XS/S
M/L
L/XL
Doesn't begin tasks independently (i.e. sits and stares)
Has messy desk/notebooks/locker/backpacks
Trouble knowing what to do when given free time
Trouble visualizing beginning steps
Trouble visualizing finishing steps
Has difficulty with time management
Is overwhelmed by large amounts of information
Trouble anticipating obstacles of future plans
Trouble seeing big picture
Needs reminders for self-care

FOCUS & ATTENTION

 *
XS/S
M/L
L/XL
Distractable
Forgetful
Daydreams
Makes Obvious Mistakes
Follows Directions
Completes Assignments
Writing Notes
Social Talking

SELF-CONTROL or INHIBITION

*
XS/S
M/L
L/XL
Fears or avoids tasks that require patience
Interrupts and disrupts activities
Blurts out ON TOPIC
Blurts out OFF TOPIC
Impulsively touches things or people
Rushes through work without reviewing
Displays physical hyperactivity (always in motion)
Dives right into problems without pausing, reflecting, developing a strategy
Talks excessively (verbalizes everything)

RIGIDITY or ANTICIPATING CHANGE

 *
XS/S
M/L
L/XL
Trouble with transitions
Trouble starting a new task before the first task is completed
Trouble switching gears (addition and subtraction problems on same page)
Perseverate on topics rather than move on
Trouble switching to a new topic/subject
Poor conflict resolution
Resists if one or two steps get in the way

WORKING MEMORY

 *
XS/S
M/L
L/XL
Easily confused by directions
Can't remember essentials (e.g. shoes)
Forgets proceedures in the middle
Trouble remembering until the end
Trouble tracking classroom discussions
Can't solve problems mentally (i.e., mental math)
Has difficulty summarizing
Requires repeated instructions
How do you hope your student will improve as a result of this program? *
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