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Fillable Online Under general supervision, supervises the

Fillable Online Under general supervision, supervises the 2025

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The document is an application form for the Kaufman-Apraxia Boot Camp (K-ABC) at The Carruth Center, designed for children diagnosed with Childhood Apraxia of Speech. It collects client and school information, therapy history, and requires a $40 application fee along with a recent speech-language evaluation. The document outlines the application process, including screening procedures and non-refundable fee policies, while emphasizing that acceptance into the program is not guaranteed.

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Click ‘Get Form’ to open it in the editor.
Begin by filling in the CLIENT INFORMATION section. Enter your child’s name, date of birth, age, and gender. Provide your name as a parent or guardian along with your address, city, state, ZIP code, phone number(s), and email(s).
In the SCHOOL INFORMATION section, indicate whether your child is currently attending school by selecting 'Yes' or 'No'. If yes, provide the school name, address, and phone number.
Move to the THERAPY HISTORY section. Indicate if your child is receiving individual speech therapy and provide details about their speech-language pathologist (SLP) if applicable.
Answer questions regarding any diagnoses related to Childhood Apraxia of Speech and other developmental conditions. Include information about additional therapy services your child may be receiving.
Review the application requirements at the end of the form. Ensure you understand all statements before signing as Mother’s/Legal Guardian 1 and Father’s/Legal Guardian 2.

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2021	4.8 Satisfied (66 Votes)

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