Admission Application

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Admission Application

Admission Application
  • SOCIAL SKILLS PROGRAM – ADMISSION APPLICATION
  • Date of Application:
  • Name of Person Completing the Application:
  • Applicant Name:
  • Address
  • Phone Number
  • Date Of Birth
  • E-mail Address (Where you would like information sent):
  • Please describe how you feel that the applicant will benefit from participation in the Social Skills program:
  • What Strengths does the applicant have with regard to social and communication skills?
  • What Needs does the applicant have with regard to social and communication skills?
  • Applicant Prescreening
  • All applicants will be required to have an in-person screening prior to admission to the program.