PROVIDER DIRECTORY

DONATE TODAY

SHOP OUR ONLINE STORE

THANKS TO OUR GENEROUS SPONSORS

Spectrum Connects

FILL OUT THE INFORMATION BELOW TO GET STARTED!

Name of Parent/Guardian (First Name and Last Name)

Name of Parent/Guardian #2 (First Name and Last Name)

Address

Phone Number

Email Address

Child’s Information

Name (First and Last Name)

Date of Birth

Gender

Name of School

Tell us about your child

Any additional diagnosis?

Additional Deficits?

Communication (mark all that apply)

1-2 words

Full Sentences

Sign Language

Gestures

3-4 words

PEC (Picture Exchange)

Augmented Communication Device (i.e. iPad)

Other Communication Skill(s)

Tell us about your child’s communication abilities:

Social Skills (mark all that apply) Play

Independent Play

Interactive Play

Physical Boundaries

Parallel Play

Eye contact

On-topic and appropriate conversation

Other Social Skill(s)

Tell us about child’s social skill

Behavior (mark all that apply)

Can transition from preferred to non-preferred activity appropriately.

Can wait in a designated area for up to five minutes appropriately.

Tell us about your child’s behavior

Aggression (mark all that apply)

Yelling/screaming

Self-injurious

Hitting/kicking others

Throwing objects

Tell us about child’s aggression

Does your child struggle with sensory processing

Touch

Light

Sound

Smell

Food

What are your child’s physical capabilities

Riding a Bike

Running

Climbing

Swimming

Jumping on a trampoline/bounce house

Bowling

Playing Video Games (physical capability)

Playing Board Games

Building Legos

Other capabilities

Tell us about your child’s capabilities

Does child have any handicaps (Mark All That Apply)

Physical

Hearing

Sight

Verbal

Other Handicaps

Interests (Mark All That Apply)

Playing Video Games

Music

Building/Making things

Hiking

Movies

Arcades

Playground Games

Sports

Favorite Video Games

Favorite Movies

Other Interests

Notes about child’s interest

Meeting Preferences

Location

Driving Radius

Boy-Girl Match Acceptable?

How Often are you willing to meet after initial meet-up?

How did you hear about the program?

MISSION

Our mission is to provide information on treatment resources for families with children diagnosed with autism, autism spectrum disorder (ASD), and related disorders.

FEAT GALLERY

MORE IMAGES

Tax ID # 88-0363321

EVENTS · FACEBOOK · TWITTER

English 702.368.3328 Espanol 702.403.6263 · JOIN FEAT

PROVIDER DIRECTORY

DONATE TODAY

SHOP OUR ONLINE STORE

Spectrum Connects

FILL OUT THE INFORMATION BELOW TO GET STARTED!

MISSION

FEAT GALLERY

EVENTS · FACEBOOK · TWITTER

English 702.368.3328 Espanol 702.403.6263 · JOIN FEAT

PROVIDER DIRECTORY

DONATE TODAY

SHOP OUR ONLINE STORE

Spectrum Connects

FILL OUT THE INFORMATION BELOW TO GET STARTED!

MISSION

FEAT GALLERY

Join FEAT, become a member!