Student support requirements Step 1 of 2 50% IntroductionThis form asks questions about the student’s preferences, interests, skills and requirements so that we can understand how best to support them.Student name(Required) Communicates wants/needs Verbally With sign / compic With gesture When prompted Understands instructions(Required) In most situations Familiar instructions in unfamiliar environments Familiar instructions in familiar environments Rarely Level of support required to:(Required)IndependentlyWith verbal promptWith verbal & visual promptWith co-active helpUndressWash handsWash him/herselfBrush teethBrush hairChoose clothingDressToilet independently - day timeToilet independently - night timeFeed him/herself with spoonFeed him/herself with forkUse knife and fork to cutThe student...(Required)Most timesSometimesRarelyNeverLikes to be aloneLikes company of other childrenLikes company of adultsSleeps through the nightBedtimeUsual bedtime(Required) Usual waketime(Required) Any bedtime routine? Food and drinkWhat food and drink does the student like for breakfast?(Required) What food and drink does the student like for lunch?(Required) What food and drink does the student like for dinner?(Required) Does the student dislike any food or drink?(Required) BehavioursDoes the student display any restrictive/repetitive behaviours, or have any obsessions?(Required)What happens if you interrupt them when they are engaged in these behaviours?(Required)Why do you think the student engages in the behaviours described above?(Required)Could any of these behaviours potentially cause harm to the student or others?(Required)What strategies have been used to reduce any behaviours of concern?(Required)Are any rewards currently given for positive behaviour? If yes, what are they?ActivitiesHow well can the student:Very wellNeeds some supportNeeds lots of supportNot well at allRide a bikeSwimCross the roadWalk with a groupBe out in the community (shops etc)What activities does the student enjoy?(Required)What activities, if any, does the student dislike?Are you currently implementing any programs with your child? Please describeOther informationIs there anything else you would like Mansfield Autism to know about the student?
