Case Manager Intake

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Case Manager Intake

Parents-This is form is for your chid's school case manger to fill out. Copy and paste link to email to them.

https://forms.gle/uZT8RCMkMLdNWJka9

Case Manager-Your student's family has contacted us about participating in Social Skills Groups this summer. Please fill this out so we can appropriately place your student in a group based on their communication skills.

Thank you for all you do for your students!!

Achieve Independence

www.achieveindependencect.com

Student Name: *

How does the student qualify for services?

Speech language Impairment

Learning Disability

Autism

ADHD/ADD

Emotional Disturbance

Intellectual Disability

Other Health Impairment

Multiple Disabilities

Visual Impairment

Hearing Impairment/deafness

Orthopedic Impairment

Other

Clear selection

Conversational Skills: Verbal

Yes

Does the student use greetings and closures appropriately?

Does the student initiate conversation appropriately?

Does the student ask follow up questions relating to a topic initiated by another?

Does the student join an on-going conversation appropriately?

Does the student demonstrate conversational turn taking?

Does the student ask questions to gain knowledge of people in the conversation?

Does the student ask appropriate social questions based on knowledge of people in the conversation?

Does the student contribute to conversations without wanting to argue?

Does the student speak without perseverating on topics?

Does the student participate in a conversation without dominating it?

Does the student select topics to discuss that are expected for the communication group?

Does the student use age appropriate vocabulary in conversation? (e.g. does not use unusually advanced vocabulary for age)

Yes