Prospective Student Questionnaire

Please note that the questions in this questionnaire are not designed to provide us with all information, but merely to give us a better understanding of your young adult. Please provide all information that you feel may be relevant to our assessment of your young adult's suitability and needs. Please also note that although every effort will be made during the assessment process to obtain relevant information, the obligation to disclose such information remains with yourself. Failure to disclose relevant information may result in it being determined that the services offered are not suitable to meet the needs of your young adult. In such an event, and given that you have signed a contract, you will be responsible to meet the obligations of that contract.

We look forward to a long lasting, mutually beneficial relationship and wish to take this opportunity to welcome you and your loved one to The Living Link family.

Date:  
Prospective Student Name:  
Parents / Caregivers names:  
Parents / Caregivers contact details:  
Complications at Birth/During Pregnancy?  
Were Milestones Normal/Delayed

(At What Age Did They Start Walking & Talking)?

 
Language & Speech

(Current Conversational Ability, Clarity Of Speech Etc.)?

 
Behavioural Problems/Issues

(At Any Age)?

 
Past & Current Interaction/Relationships With Family /Parents/Caregivers?  
Participation At Home With Independent Living/Household Skills

(Cooking, Cleaning, Money Management, Travel)?

 
Schooling History

(Mainstream / Special Education)?

 
Has The Prospective Student Had Any Assessment/ Tests/Scans In The Last 2 Years?

(If Yes, Please Bring To The Screening Assessment)

 
Accidents/Head Trauma

(Ever Lost Consciousness – If So What Happened)?

 
Medication

(Past & Present)?

 
What was the medication prescribed for?

(Past & Present)?

 
Any Psychiatric/Medical Diagnosis?  
Any Physical Disability?  
 
Comments:  

Note: All Entry's subject to screening.