Baylor Clinic for Assessment, Research, and Education
Baylor University Center for
Developmental Disabilities
Educational Assessment & Goal Planning
Program
Information & Application Packet
The Clinic for Assessment, Research, and Education (CARE)
Educational Assessment & Goal Planning Program
The purpose of this program is to identify your child’s strengths and weaknesses in
order to provide an individualized treatment program at home or school.
The assessment program will begin with an in-depth parent interview, followed by a
direct assessment of the client using the Verbal Behavior Milestones Assessment and
Placement Program (VB-MAPP).
The results of the interview and VB-MAPP will be used to identify 10—20
individualized, specific, measurable educational goals that can be shared with your
child’s Individualized Education Program (IEP) team or private therapy provider.
While the VB-MAPP is conducted for children receiving ABA therapy, this program is
offered as a stand-alone service for families wanting to identify additional educational
goals to target outside of therapy provided at CARE.
Cost: The cost of the program is $125 for a stand-alone assessment (i.e., child is not
currently receiving ABA services via Baylor CARE). The cost of the program for
existing ABA clients is $75. Payment programs and scholarships may be available.
Application: To apply for the program, please complete the attached application and
return to the Baylor CARE via mail, email, or fax.
For more information, contact:
Desiree Ramirez
2201 MacArthur Dr., Suite 101
Waco, Texas 76708
care@baylor.edu
(254) 537-1042
Clinic for Assessment, Research, and Education (CARE)
Educational Assessment & Goal Planning Application
Application Date:
Participant’s Name:
(LAST)
(FIRST)
(MIDDLE)
(LAST)
(FIRST)
(MIDDLE)
(STREET)
(CITY)
Guardian’s Name:
Address:
Gender:
(STATE)
Date of Birth
(ZIP)
Grade Level (if applicable):
(MM/DD/YYYY)
School District:
Parent/Caregiver Phone Number (cell phone, if available):
Home Phone Number:
Work Phone Number:
Parent/Guardian Email:
Preferred Method of Contact:
Diagnosis:
Source of Diagnosis:
Participant Lives with:
Mother & Father
Mother
Other/Legal Guardian (please specify):
Father
List other children in the household:
Name:
Age:
Name:
Age:
Name:
Age:
Name:
Age:
Name:
Age:
Name:
Age:
How did you hear about this program?
Identify participant’s favorite foods, activities, items, etc.:
Please identify participant’s current skill level. Check one:
Adaptive Behavior Skills:
Independent
Needs Reminders/Instruction
Needs Physical Assistance
__________
__________
__________
Hand Washing __________
__________
__________
Dressing
__________
__________
Toileting
__________
Communication Skills (check all that apply):
No Speech sounds
Babbles (non-words)
Says 1 – 10 words
10+ 1-word phrases
2 – 3 word phrases
Short sentences or more
Imitates words & sounds
Echolalia (nonfunctional repeating of sounds)
Primary mode of communication is verbal language
Primary mode of communication is sign language. If yes, approximate number of signs:
Primary mode of communication is pictures/PECS. If yes, approximate number of pictures:
Primary mode of communication is electronic communication device. If yes, approx. # of buttons:
Challenging or Problem Behaviors of Concern (list and rate):
1. ____________________________________________
Mild
Moderate
Severe
2. ____________________________________________
Mild
Moderate
Severe
3. ____________________________________________
Mild
Moderate
Severe
4. ____________________________________________
Mild
Moderate
Severe
5. ____________________________________________
Mild
Moderate
Severe
6. ____________________________________________
Mild
Moderate
Severe
7. ____________________________________________
Mild
Moderate
Severe
8. ____________________________________________
Mild
Moderate
Severe
Describe why you would like your child to participate in this program:
OPTIONAL: Describe any unique financial needs that influence your need for scholarships to assist with
program fees. Please note that scholarships are granted only when available:
Applications may be submitted by email, fax, or mail.
For questions or more information, please contact Kristen Mainor.
Desiree Ramirez
2201 MacArthur Dr., Suite 101
Waco, TX 76708
care @baylor.edu
Phone: 254-537-1042