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Parent/Guardian Questionnaire
Name of Applicant (*)
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Name of Parent
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Date
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Motivated
Not True
Sometimes True
Often True
Always True
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Reliable
Not True
Sometimes True
Often True
Always True
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Self-advocates
Not True
Sometimes True
Often True
Always True
Invalid Input
Follows a daily schedule
Not True
Sometimes True
Often True
Always True
Invalid Input
Uses strategies to cope with stress
Not True
Sometimes True
Often True
Always True
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Easily adjusts to new situations
Not True
Sometimes True
Often True
Always True
Invalid Input
Generally liked by peers
Not True
Sometimes True
Often True
Always True
Invalid Input
Gets along with people of authority
Not True
Sometimes True
Often True
Always True
Invalid Input
Able to use people as a resources
Not True
Sometimes True
Often True
Always True
Invalid Input
Reacts appropriately to emergencies
Not True
Sometimes True
Often True
Always True
Invalid Input
Often loses temper
Not True
Sometimes True
Often True
Always True
Invalid Input
Often seems worried
Not True
Sometimes True
Often True
Always True
Invalid Input
Lacks confidence in new situations
Not True
Sometimes True
Often True
Always True
Invalid Input
Separates own problems from those of others
Not True
Sometimes True
Often True
Always True
Invalid Input
Trouble making everyday decisions
Not True
Sometimes True
Often True
Always True
Invalid Input
Easily distracted, concentration wanders
Not True
Sometimes True
Often True
Always True
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Is able to follow daily personal care routine
Not True
Sometimes True
Often True
Always True
Invalid Input
Is able to do chores around the house
Not True
Sometimes True
Often True
Always True
Invalid Input
Is able to go in the community on his/her own
Not True
Sometimes True
Often True
Always True
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Is able to do his/her own laundry
Not True
Sometimes True
Often True
Always True
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Please describe the applicants’ strengths
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Please write about the student’s interests and hobbies
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How do you expect J-CHAI to help the applicant?
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J-CHAI Application
Complete Application Procedures
J-CHAI Application Part 1
J-CHAI Application Part 2
J-CHAI Application Part 3
Applicant Questionnaire
Parent/Guardian Questionnaire
Confidential Applicant Recommendation Form
Authorization Form
Download Application (PDF format)
Download Recommendation Form (PDF format)
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