My name is:

My friends and family call me:

This is who lives with me at home:

These are the therapists and doctors who support me and my family and how to reach them:

These are other family, friends, and supports that are special to my family and when my family or I usually see them:

Here are some things that I REALLY enjoy:

Here is how you know I’m happy:

Here are some things that are challenging for me to do:

Here are some things that I wish didn’t ever have to happen because I dislike them so much:

Here’s what I do when I’m not happy about something:

These are the ways in which I communicate to others what I’m thinking, feeling, wanting, and don’t want:

These are the ways I get around my environment and how I move and use my fingers and hands:

These are the ways I’m able to eat, and what foods I like and don’t like:

This is my experience being around other children my age and what usually happens in those settings:

This is how people who care for me let me know what behavior is expected of me and how they handle it when I’m misbehaving:

This is how I best calm down when I am upset:

These are some things that my family would like to see me learn over the next year:

This is what you can expect from my family at home when working with me:

This is what my family would like as far as communication about what I am learning and how I am doing at school:

These are my family’s hopes and dreams for me: