This questionnaire is tailored toward gaining a better understanding of the potential traveler’s level of functioning in the areas of socialization, independence and over-all level of functioning.

A more detailed medical evaluation will be required to be completed once your traveler has been accepted into our program.

Please answer the following questions to the best of your ability with complete honesty with regard to your answers. Remember, this is a program for those with special needs. We need to know about strengths and weaknesses to better service your traveler’s needs. Therefore, answering questions honestly and fully will contribute to a successful summer experience for all.

Subjects covered in the application are: Independence, Psychological / Behavioral, Communication Skills and Socialization.