Please complete the following information. We will contact you within 24 hours to discuss the applicant's eligibility for our program.
Parent/Guardian EMAIL Address(es)
Parent/Guardian phone numbers
Where did you hear about us?
Which location are you interested in?
Falls Church, VA
Briefly tell us why you are applying to this program, as well as whether the applicant graduated from high school and if any post-secondary coursework was completed, including area(s) of study.
Please describe the applicant's interests, favorite subjects, preferred ways to spend free time, and any scheduled activities (such as clubs, sports, etc).
Please describe the applicant's current areas of need and any social skills deficits or challenges. What are your goals for these areas? What would you like the applicant to be able to do as a result of participation in our program?
Does the applicant have any diagnoses, receive special education services, or participate in family or individual counseling?
Any dietary restrictions, allergies, or medical issues? Sensitivity to certain sounds, florescent lights, etc?
Please provide the name, email, and phone number for at least one teacher or therapist who knows the applicant well and can speak to his/her strengths and needs.
If there is anything else we should know, please share it here.
Thank you for your application to Kate McClain Social Skills.
We will be in touch soon!
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