1. Tell us about your child

17% of survey complete.

* 1. Your child's first and last name?

* 2. Demographics

* 3. What is his/her diagnosis?

* 4. Briefly describe his/her social difficulties?

* 5. What are the typical triggers that make your child upset?

* 6. What is an effective way to intervene when your child becomes upset?

* 7. What services is your child currently receiving outside of school?

* 8. Describe his/her academic difficulties that you want him/her to improve over the summer?

* 9. Briefly describe his/her strengths?

* 10. What incentives, if any, motivate your child (e.g., toys, money, food, TV, video games, etc...)

* 11. Any current or history of aggression, running away or destruction of property?

* 12. Any self-care issues (e.g., toileting, changing clothes, etc...)

* 13. Any medical or physical problems? Allergies?

* 14. Any food issues or dietary restrictions?

* 15. Does he/she take medication? If yes, please describe with names of medications, dosages, times of dosages, etc...