Fillable Threshold Program Admissions Application Parent/Guardian Questionnaire (Lesley University)

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Threshold Program Admissions Application Parent/Guardian Questionnaire (Lesley University)

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Threshold Program at Lesley University
Threshold Program Admissions Application
Parent/Guardian Questionnaire
Name of Applicant ______________________________________________________________________________
Why are you interested in the Threshold Program for the applicant? _______________________________________
_______________________________________________________________________________________________
Please rate the applicant on the following characteristics on a scale of one to five (with one low/ five high). Enter your
ratings under the categories to which you feel qualified to respond.
GENERAL School Job Home
Initiative _____ _____ ______
Motivation _____ _____ ______
Reliability _____ _____ ______
Perseverance _____ _____ ______
General Attitude _____ _____ ______
Comments: ____________________________________________________________________________________
_______________________________________________________________________________________________
INTERPERSONAL School Job Home
Ability to relate to:
Peers with ID ______ ______ _______
Peers without ID ______ ______ _______
Teachers ______ ______ _______
Work supervisors ______ ______ _______
Young children ______ ______ _______
Elderly people ______ ______ _______
Comment on style of interaction and specific strengths and weaknesses in social interactions: _________________
________________________________________________________________________________________________
Threshold Program at Lesley University
JUDGEMENT/DECISION MAKING
Ability to: School Job Home
Make everyday decisions using good judgment _____ _____ _____
Act in an emergency using good judgment _____ _____ _____
Asking for questions/clarification) _____ _____ _____
Comments: (Use examples if possible.)
________________________________________________________________________________________________
________________________________________________________________________________________________
EMOTIONAL ADAPTABILITY
Ability to: School Job Home
Cope with stress ______ ______ _______
Adjust well to new situations ______ ______ _______
Separate own problems from problems of others ______ ______ _______
Ability to listen to constructive criticism ______ ______ _______
Comments: (Be specific: what types of situations does the applicant find stressful? What coping mechanisms are
used?)
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Please list all counselors and therapists who have seen applicant.
Name________________________________________ Nature Of Service________________________
Address_____________________________________________________________ Age Seen______
Name________________________________________ Nature Of Service_______________________
Address_____________________________________________________________ Age Seen______
Please list any medical conditions _____________________________________________________
List specific ID diagnoses _____________________________________________________
Threshold Program at Lesley University!
TIME MANAGEMENT & ORGANIZATION School Job Home
Ability to:
Attend to daily schedule ________ ______ _________
Plan and carry out activities ________ ______ _________
Prioritize ________ ______ _________
Keep track of belongings ________ ______ _________
Complete and turn in homework on time ________ ______ _________
Does the applicant have a good sense of direction? ☐ Yes ☐ No
If no, please describe any strategies used to improve navigation skills. __________________________________
____________________________________________________________________________________________
I CERTIFY THAT ALL THE INFORMATION IN THIS APPLICATION IS TRUE AND COMPLETE TO THE BEST OF MY
KNOWLEDGE.
______________________________ ____________ _____________________________
____________
Name of Applicant Date Name of Preparer Date
If not parent, relationship to applicant _______________________________________________________
The completed form may be emailed to: thadmissons@lesley.edu
Lesley University is an Equal Opportunity/Affirmative Action institution. The University administers all its policies regardingadmission,
education, school activities, employment, and promotion without regard to race, color, sex, sexual orientation, religion, national origin, age,
disability, or veteran status.
Threshold Program at Lesley University
29
Everett Street, Cambridge, MA 02138
617.349.8182
thadmissions@lesley.edu
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Threshold Program Admissions Application ParentGuardian Questionnaire (Lesley University)

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Completed 16 August 2020

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