STEP Registration STEP (Students Transitioning into Employment Program) Registration Please read the following information carefully before proceeding to the form.The STEP Program enables high school students who self-identify with Autism Spectrum Disorder to participate in targeted career development activities and exploration. With an individualized approach, students build self-awareness and skills through structured learning sessions and community mentorship placements with the ultimate goal of identifying appropriate employment or attending post-secondary choices upon school leaving. The STEP Program is suitable for students in Level 2 up to school leaving year. STEP is designed for students whose primary method of communication is verbal language; are comfortable working independently, or with minimal support; and are interested in exploring career options though work placements and/or attend post-secondary education. Whenever possible we encourage students to complete the registration themselves. Is your 2018/2019 ASNL Membership paid? Yes No Who is filling this form in?* I am filling out this form as a candidate I have a guardian/guidance counsellor filling out this form on my behalf Candidates Name* First Last Gender* Male Female Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email* Date of Birth:* Date Format: MM slash DD slash YYYY High School:*Age*Guardian Name (1) First Last Relationship to CandidateHome PhoneCellWorkEmail Guardian Name (2) First Last Relationship to CandidateHome PhoneCellWorkEmail Emergency Contact Person/Alternate Pick-up Person (other than above)* First Last Relationship to Candidate*Phone*Medical Concerns (i.e.: allergies/Epipen, asthma, physical limitations, etc.):Does the candidate experience seizures? Yes* No *an additional form will be completed upon registration If yes, please describe briefly.Sensory SensitivitiesTactileAuditorySmellMovementVisualOtherPlease list any interests or hobbies:Please list any aversions/ not-preferred activitiesWhat are some of the candidate’s strengths?What are some skills that the candidate is working on to improve?Please describe any behavioural concerns (wandering/running from stressful situations, reactions to stress, etc.)Strategies for regulation or de-escalation include:Strategies for regulation or de-escalation include:Has the candidate completed Career 2201? Yes No Does the candidate have previous employment experience? Yes No If yes, where was the candidate employed and what tasks were they taking part in?Does the candidate have previous volunteer experience? Yes No If yes, where did the candidate volunteer and what tasks were they taking part in?What type of community access (i.e. lessons, leagues, clubs) is the candidate currently engaged in?When taking part in community activities does the candidate require supervision? If so, please explain the level of supervision the candidate requires (i.e.: one on one supervision)Consent for Information Sharing* I, as the parent/guardian of the above-named candidate, grant permission to share information with the guidance counsellor at my child’s school. I, as the parent/guardian of the above-named candidate, decline permission to share information with the guidance counsellor at my child’s school. I, as the parent/guardian of the above-named candidate, grant permission to share information internally. I, as the parent/guardian of the above-named candidate, decline permission to share information internally. Consent to share information will allow the coordination of quality, individualized programs for each participant. Information sharing will be limited to: • Individualized strategies and goals to support transitioning from high school; • Individualized strategies and routines to help with behavior/regulation; • Information shared at ISSP/IEP meetings. Photograph Waiver* I, as the parent/guardian of the above-named participant, grant permission to use photos/videos. I, as the parent/guardian of the above-named participant, decline permission to use photos/videos. I hereby grant permission to Autism Society, Newfoundland Labrador (ASNL), and its representatives, to photograph and videotape my son/daughter, and otherwise capture their image. I further grant ASNL and its representatives the right to reproduce, use, exhibit, display, broadcast and distribute these images and recordings in any media now known or later developed for promoting, publicizing or explaining ASNL and its activities including their website. Such photographs are the property of ASNL and may be altered or combined with other images, text, and graphics without notifying me. Thank you for your interest in the STEP Program. If you have additional questions please contact Sarah O’Grady, Coordinator, Career Services sogrady@autims.nf.net or 722-2803 ex 237.
