Current Page 1 Page 2 Page 3 Complete Contact Information First Name Last Name Today's Date Email Address Disability Date of Birth What Should We Know? Things that make me happy and that I enjoy doing are: Things that make me unhappy and that I do not enjoy doing are: I am good at: I am not so good at: I love talking about: The best ways to transition to a new activity is by: If you want to get and keep my attention, you should: When I begin to get upset, I: If I begin to become upset, the best ways to support me are: Does your child have behavioral concerns at home or in the classroom? No Yes Please Explain Check all that apply: Wander or leaves the group Will Take others belongings Will ask for assistance when needed Easily distracted/difficulty focusing Put self at risk Physically aggressive to others Verbally aggressive to others Recognizes danger Runs away/flight risk Has Specific Triggers No Yes Please Specify Has specific fears/concerns to be aware of: No Yes Please Specify