| The admissions process to the Day Program at Aurora Strategies, Inc. is as follows:
- Fully complete & submit this application with a non-refundable $100.00 application fee.
- If the parent(s), Full Day Program staff, and other appropriate individuals together, based on the application and supporting documentation, believe it would be appropriate to continue the enrollment process, Aurora Strategies will contact you to schedule a visit/interview for you and your student.
- If necessary, applicant will meet with other teachers/specialists for further evaluation.
The applicant should also include:
- Any assessment reports or psychological evaluations reports from the past three years.
- Any other information that will help us to fairly and completely evaluate the applicant.
Please note that any paperwork submitted to Aurora Strategies is the property of Aurora Strategies, and you should retain your own copies of the documentation. Aurora Strategies can not make copies for you.
Based on these visits and the application materials, The Day Program at Aurora Strategies, Inc. will make a decision about admission to the program.
Notice of Nondiscriminatory Policy
The Day Program at Aurora Strategies, Inc. admits students of any race, creed, or national and ethnic origin to all the rights and privileges, programs and activities generally accorded and made available to students at the school. It does not discriminate on the basis of race, creed, color, or national and ethnic origin in administration of its educational policies, admissions policies, or other school-administered programs.
Accredited by the Georgia Accrediting Commission |
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Applicant's General Information
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First Name :
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Last Name :
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Sex :
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Birth Date (month / day / year) :
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Address :
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City :
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State :
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Zip Code :
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Home Phone (111-111-1111) :
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Family Information
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Parent Marital Status :
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Mother's Information
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Mother's Name :
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Mother's Daytime Phone (111-111-1111) :
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Mother's Nighttime Phone (111-111-1111) :
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Mother's Cell Phone (111-111-1111) :
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Mother's Address (if different from child's) :
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Mother's Email :
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Mother's Occupation :
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Mother's Employer :
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Mother's Employer Address :
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Father's Name :
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Father's Daytime Phone (111-111-1111) :
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Father's Nighttime Phone (111-111-1111) :
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Father's Cell Phone (111-111-1111) :
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Father's Address (if different from child's) :
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Father's Email :
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Father's Occupation :
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Father's Employer :
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Father's Employer Address :
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Sibling's Information
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Sibling 1 Information
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Name :
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Age :
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School Attending :
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Sibling 2 Information
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Name :
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Age :
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School Attending :
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Sibling 3 Information
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Name :
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Age :
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School Attending :
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Sibling 4 Information
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Name :
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Age :
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School Attending :
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Sibling 5 Information
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Name :
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Age :
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School Attending :
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Emergency Information
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Others to contact in case of emergency (Name / Phone # / Relationship):
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Emergency Contact 1
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Name :
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Relationship :
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Phone Number :
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Emergency Contact 2
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Name :
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Relationship :
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Phone Number :
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Emergency Contact 3
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Name :
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Relationship :
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Phone Number :
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Others authorized for pick up (Name / Relationship)
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Authorized Pick Up 1
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Name :
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Relationship :
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Authorized Pick Up 2
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Name :
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Relationship :
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Medical Information
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Child’s primary physician :
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Child’s primary physician phone :
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Child's primary physician address :
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Has your child seen by a Psychiatrist, Psychologist or Counselor? :
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Child’s Psychiatrist
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Name :
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Phone :
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Address :
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Child’s Psychologist
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Name :
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Phone :
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Address :
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Child’s Counselor
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Name :
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Phone :
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Address :
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Does your child have a diagnosis? :
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Is your child currently taking any medication? :
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Current Medication(s)
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Medication 1
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Name of Medication :
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Dosage :
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Medication 2
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Name of Medication :
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Dosage :
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Medication 3
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Name of Medication :
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Dosage :
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Please list any known Allergies :
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Is your child on a special diet? :
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If yes, please describe :
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Therapeutic Services
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Has your child seen by an Occupational Therapist, Speech/Language Therapist, Physical Therapist :
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Occupational Therapist
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Name :
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Phone :
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Address :
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Dates of Service :
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Frequency :
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Speech/Language Therapist
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Name :
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Phone :
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Address :
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Dates of Service :
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Frequency :
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Physical Therapist
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Name :
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Phone :
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Address :
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Dates of Service :
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Frequency :
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Social/Emotional History
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Please describe how your child interacts with you :
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Please describe how your child interacts with siblings :
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Please describe how your child interacts with peers :
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How does your child function in group settings? :
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What types of activities is your child interested in? :
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Please describe your child’s typical play/interaction skills. (Include information about the ages of the people your child chooses to play with; if your child chooses to be a leader, follower or loner; how many people your child is comfortable playing with at one time; and whether your child prefers a few close friends or a lot of acquaintances. Also include favorite play “themes”) :
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When your child is upset, what behavior do you typically see? (kicking, biting, screaming, hurts self/others, withdrawn, leave room/activity, refuse to talk) :
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How long does it take for your child to “recover” when upset? :
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What does your child do to calm him/herself? :
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Does your child exhibit impulsive behavior? If yes, please describe :
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Does your child exhibit aggressive behavior? If yes, please describe :
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Does your child exhibit anxiety? If yes, please describe :
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Please describe how your child makes transitions between people, activities or environments (include level of independence during transitions, need for transitional objects and/or need for advance preparation about schedule changes) :
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Does your child need constant reminding to initiate or complete familiar tasks? If yes, please describe :
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Please describe your child’s sensitivity to movement. (Include information about the types of movement your child likes and dislikes, the frequency with which your child seems to seek movement and your child’s behavior regarding being moved off the ground) :
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Does your child seek out tight spaces or spaces under pillows or cushions? If so, please describe :
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Please describe a typical day for your child. (Include information regarding all activities: morning routine, transitions to and from school and behaviors that might be seen in a typical day) :
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