Stepping Stones 2011-2012 Admissions Information and Application for the Three and Four Year Old Classes
Mission of Atlanta Speech School Mission Statement: To help each person develop his or her full potential through language and literacy. PRIMARY VALUES The needs of each child and adult we serve come first. Language and literacy are fundamental to productive and enriched lives. CORE PRINCIPLES Quality We strive for unequivocal excellence in every program measured by the quality and depth of impact on each person we serve. We recognize that excellence demands the continuing pursuit and application of the most advanced knowledge, research, and practices in our fields of service and expertise. We understand that the recruitment, development, and support of an exceptional faculty and staff are essential to meeting our mission. We integrate teaching, clinical practices, and advocacy within our organization for the maximum benefit of those we serve. Relationships We build relationships based on the highest trust with each child, family, and adult we serve. We seek relationships with other institutions, public and private, that share our resolve and commitment to develop the full potential of each person. We share our intellectual capacity and experience with other professionals and opinion leaders, and we listen and learn from their experiences, for the benefit of all children. We value teamwork, personal responsibility, integrity, and respect in our learning and work environments. Resources We are grateful for the time, talents, and financial resources that are invested in the lives of the persons we serve. We are committed to our financial aid program, as we seek to assist all persons in need of our services, regardless of their financial circumstances. We practice thoughtful stewardship of our resources, recognizing our responsibilities to the persons we currently serve and the need to be an institution prepared to serve future generations. History The Atlanta Speech School began as a vision of Mrs. Katherine Kitty Cathcart Hamm, mother of a son who was deaf. After her son learned to speak at the Central Institute for the Deaf in St. Louis, Mrs. Hamm envisioned a similar school in Atlanta where individuals of all means could benefit from specialized instruction. With the aid of volunteers from the Junior League of Atlanta, Mrs. Hamm opened the Junior League School for Speech Correction on June 6, 1938. On that historic day, fifty students were registered, a waiting list was formed, and a legacy was established. In the School s 72-year history, its programs have adapted to the changing needs of the community while remaining true to the fundamental ideals that were established when it was founded: To provide instruction to those in need of our services, without regard to their financial limitations. To maintain a caring and professional atmosphere that is open to challenges. To continue to explore and pioneer developments in communication and learning. The Stepping Stones preschool program was established in 2002.
Programs and Services of the Atlanta Speech School The Atlanta Speech School is a truly unique organization with four educational programs, multiple clinical and community programs, and a professional development institute. All of the programs and services offered by the Atlanta Speech School are interrelated by the importance of language in academic success and in everyday life. Academic Programs The Katherine Hamm Center is an auditory/oral education program for infants, toddlers, and elementary-age children who are deaf or hard of hearing. Auditory-oral education enables the child to communicate with spoken language rather than sign-language. Students utilize amplification in the form of cochlear implants or hearing aids. The Anne & Jim Kenan Preschool is an early childhood development program for children ages two through five. The Kenan Preschool was founded to serve as a mainstreaming site for Hamm Center students and continues to work with these students today. Stepping Stones is a preschool program for children ages three and four with speech and/or language delays. The program incorporates education and therapy with a speech-language pathologist, special education teacher, and occupational therapist on its staff. The Wardlaw School serves children in kindergarten through 6 th grade who have average to superior intelligence and mild to moderate language-based learning disabilities. The Wardlaw School emphasizes personalized instruction and prepares children for a mainstream educational environment as quickly as they are ready. Clinical and Community Programs The Speech-Language Pathology & Audiology Clinic provides diagnostic testing and therapy for children and adults on an outpatient basis. The Learning Evaluation Clinic provides psychoeducational evaluations for children ages four to eighteen years. The Occupational Therapy Clinic serves children with sensory integration, handwriting, or fine/gross motor difficulties. The Rollins Center for Language & Learning is a professional development institute for educational professionals and parents throughout the Southeast. Learning Lab provides specialized individual or small group academic remediation for children who are having academic difficulty in school. After School and Summer Camp programs provide fun and educational enrichment opportunities for children with and without special needs.
Stepping Stones The Stepping Stones Preschool of Atlanta Speech School is an early intervention program that provides therapeutic education for children ages three and four with speech and/or language delays. Our program incorporates a unique collaborative approach designed to assist in the child s growth and development. The Stepping Stones classroom offers the young learner an opportunity to explore and learn at his or her own rate through direct teaching, student directed activities, and interaction with classroom materials and other children within the class. The prepared environment, individualized instruction, and the freedom to explore within the classroom combine to meet the needs of the total child within cognitive, social, emotional, physical, and language development domains. The instructional curriculum within each classroom is adapted from The Carolina Curriculum for Preschoolers with Special Needs with supplemental goals developed by Stepping Stones staff members. This program provides a thorough outline for educating our students in a developmentally appropriate manner. In addition to the program curriculum, therapists and teachers incorporate clinical expertise into daily planning to provide instruction that meets each child s individual needs. A supplemental series of individualized goals created with parents during the Fall conference that are specific to each child s needs also guide each student s educational experience within Stepping Stones. Program Goals 1. Develop and foster increased verbal communication patterns within each student. 2. Develop and foster increased pre-academic skill development, with special emphasis placed upon the learning of pre-literacy skills. 3. Develop and foster increased fine motor and sensory integration skills within each student. 4. Develop a positive self-concept and acceptance of oneself as a unique individual. 5. Through interaction with peers, the child will develop increased social skills. 6. Develop increased self-expression through dramatic play, interaction with groups and/or teachers, and arts. Teaching Staff Stepping Stones recognizes the importance of maintaining a low student-teacher ratio. Our specialized team is made up of the following individuals: Speech-language pathologist Educational specialist Occupational therapist Full-time teacher assistant School psychologist Our specialists incorporate a collaborative approach, providing the highest level of instruction for the students in order to maximize their learning potential. Our staff strives to maintain a constant contact with the family to relay feedback and to give instruction for practice at home. Additional Services Consultation with specialists Comprehensive educational case management Parent observation booths Parent classroom volunteer opportunities Consultations with parents at regularly scheduled conferences three times a year or by request at any time.
Class Information Three Year Old Class Pebbles Meets: Monday-Thursday Hours: 9:00 am -12:00 pm Number of classes: 2 Class size: 10 children in each class Enrichment: music classes Four Year Old Class Boulders Meets: Monday-Friday Hours: 8:30 am -2:00 pm (M, W, F) 8:30 12:00 pm (T, Th) Number of classes: 2 Class size: 12 children in each class Enrichment: music and movement classes
Admissions Calendar _ Monday, October 25, 2010 January 14, 2011 Mid to Late January, 2011 Late January-March, 2011 Early April, 2011 Applications for 2011-12 Year Available Application Due Date Applications are reviewed by Admissions Committee Observations and Screening Children who are invited for an observation will have the opportunity to participate in a small group lesson within our preschool classrooms. The observation is informal and every effort is made to help the children feel comfortable. The purpose of the observation is to help determine whether our program meets the needs of each child. Children will also participate in a brief cognitive screening during the evaluation process. Screening fee of $145.00 is payable by cash or check at the time of initial screening. Decision letters mailed Decision letters mailed with enrollment agreement for Applicants to three and four year old classes. Applications are accepted for the 2011-12 school year until all spots are filled. Our preference is for all applications to be reviewed during the timeframe listed above. However, we may be able to consider applications that are submitted after January 14, 2011. Application Information In order for your child s application file to be complete and reviewed by the admissions committee, the following information should be submitted by January 14, 2011: Completed parent portion of application A copy of your child s most recent speech language evaluation and any accompanying therapy progress reports. Reports from any other specialists seen by your child are requested as well. Completion of Early Childhood Questionnaire (enclosed) by your child s classroom teacher or day care provider. If your child is not enrolled in a group based program, we would appreciate having the form completed by your child s speech language pathologist or any other specialist familiar with your child. The questionnaire may be turned in by parents or directly from child s teacher via mail, e-mail, or fax. *A recent photograph of your child is requested, but not a requirement. Please return all application information to: Melissa Schmoker, Stepping Stones Coordinator 3160 Northside Parkway, NW Atlanta, GA 30327
Stepping Stones Application _ Name of Child: Date of Application: Preferred Name: Gender: Male Female Applying to: 3-year class 4-year class Date of Birth: Child s age on 9/1/11: years months Address: County of residence: Father's Name: Father s Age: Street City State Zip School district: Mother's Name: Mother's Age: Education: (highest grade completed) Education: (highest grade completed) Occupation: Occupation: Employer: Employer: Home Phone: Home Phone: Business Phone: Cell Phone: Email Address: Business Phone: Cell Phone: Email Address: Physician: Address: Referred by: Address: Phone: Phone: Name of person completing this application: Relation to applicant:
1. Has your child been seen at the Atlanta Speech School before? Yes No If so, which clinic and/or school? Kenan Preschool Speech Language Clinic Stepping Stones Audiology Clinic Wardlaw School Learning Evaluation Clinic Katherine Hamm Center Occupational Therapy Clinic Learning Lab 2. Do you have another child who may be attending the Speech School in 2011-2012? Yes No If yes: Department: Kenan Preschool Child s name Stepping Stones Katherine Hamm Center Wardlaw School 3. Describe any affiliation you have had with the Speech School: 4. How did you become interested in Stepping Stones? 5. Why have you chosen to apply to this program? 6. How do you anticipate this program will meet the needs of your child? 7. In your own words, describe as completely as possible the concerns you have in regard to your child.
8. When did you first become concerned about the problem? 9. In your opinion, what is the cause of the problem? PRENATAL AND BIRTH HISTORY 1. During the pregnancy, did the mother experience any unusual illness, condition or accident, such as German measles, Rh incompatibility, false labor, etc? If so, please describe. 2. List medications taken by mother during pregnancy: 3. Were there any problems with delivery, such as breech birth, Cesarean, etc? If so, please describe: 4. Is your child adopted? If so, at what age was he/she adopted? Length of pregnancy: Duration of labor: Hospital name: Anesthetic used: Child s birth weight: Conditions immediately following birth: Did the infant have trouble starting to breathe? Yes No Was infant blue? Yes No Did infant have sucking/swallowing difficulty? Yes No Was infant jaundiced? Yes No Was birth weight regained quickly? Yes No Did infant have seizures? Yes No Did infant have feeding problems? Yes No Did infant have scars/bruises? Yes No Did infant have other problems? Yes No Apgar rating:
DEVELOPMENTAL HISTORY Approximate age when your child: Held up head alone: Pulled to standing position: Walked without assistance: Sat alone without support: Began to crawl: Fed self with spoon: Slept through night: Toilet trained: Bladder: day night Bowel: day night If your child is not toilet trained, does he/she display interest in toilet training or any readiness indicators? If so, please describe. Could dress self (except for tying): Managed snaps: Managed zippers: Managed buttons: Tied shoes: Does child seem to be: right-handed left-handed Is the child awkward using his/her hands? Does your child: Draw shapes/write letters? Yes No Skip? Yes No Hold and scribble with a crayon? Yes No Hop on one foot? Yes No Cut with scissors? Yes No Fall or lose balance easily? Yes No Climb stairs using alternate feet? Yes No Open doorknobs? Yes No Climb on high play equipment? Yes No Push riding toy/pedal and ride tricycle or big wheel? Yes No Does your child have any difficulty tolerating: Being held? Yes No Having hair groomed? Yes No Having teeth brushed? Yes No Loud noises? Yes No Having face or mouth washed? Yes No Certain specific sounds? Yes No
SPEECH AND ORAL MOTOR HISTORY Language(s) spoken in the home: Did your child have any difficulty: Nursing or taking a bottle? Transitioning to baby food? Drinking from a cup? Chewing, swallowing, or clearing food from mouth? Eating solid foods? Drinking with a straw? With reflux? Tolerating a variety of food textures and tastes? Does your child: Suck thumb, fingers or pacifier? Chew on fingers, toys or blanket? Click his/her tongue? Drool? Blow bubbles? Make raspberry sounds? At approximately what age did your child: Coo? Use jargon? Make babbling sounds (like gaga )? Use rising inflection to ask questions (like cookie? )? Use 2-3 single words spontaneously besides mama dada (not imitation)? Can you understand everything your child says? Can others understand everything your child says? Say first word? What was first word? Use 2-word phrases to communicate ( me go, mama eat )? Have approximately 50 word vocabulary? Use sentences? Yes No Yes No Please explain: Does your child seem to have trouble understanding/following directions? Does your child seem to have trouble understanding story sequences? Does your child stutter (get stuck on words, repeat words, restart sentences)? Yes No Yes No Yes No Is your child s voice: Hoarse? Yes No Too nasal? Yes No Too soft or too loud? Yes No High- or low-pitched? Yes No
Has your child had a speech examination prior to this time? Yes No If so, when, where and with whom? Has your child ever received speech therapy? Yes No If so, when, where and with whom? Does your child receive speech therapy at this time? Yes No If so, when, where and with whom? 1. Describe how your child expresses his/her ideas: 2. Did speech learning ever seem to stop for a period? If so, did it correspond to any specific event (ear infections, stress, illness)? 3. Has your child ever spoken better than he/she does now? 4. Has there been a change in your child s speech in the last six months? If so, describe: 5. Does your child seem to be aware of a speech difficulty? If so, describe: 6. Are there any instances of speech or hearing problems in the family (siblings, parents, grandparents)? If so, describe: Please request that previous evaluation and progress reports be sent to us. We will not be able to consider a child s application for screening and enrollment until a speech/language evaluation is completed and results are submitted to the admissions committee.
PERSONAL AND FAMILY HISTORY Other children in your family Name: Age: Grade: Any Known Problems: 1. Does your child s play involve: Independent play (parallel play)? Pretend play (imagination)? Cooperative play (games, shared play)? 2. How does your child get along with other children in your family? 3. How does your child get along with friends/playmates? 4. What are your child s favorite activities? 5. What type(s) of discipline work(s) best for your child? 6. How long can your child attend to: TV? Listen to a story? Occupy him/herself with toys? 7. Has your child been seen by a psychologist/social worker/psychiatrist for behavior management? Who? When? We would appreciate having any reports or relevant material be sent to us.
SCHOOL HISTORY What school does your child currently attend? Level: Address: Street City State Zip Teacher(s): At what age did your child start school? Where? 1. Have teachers noted any areas of difficulty? If so, please describe. 2. How does your child get along with others at school? 3. Does your child receive any supportive services (tutoring, occupational therapy, counseling, other)? If so, please describe. 4. Has your child received any previous psychoeducational evaluations, speech/language evaluations, or occupational therapy evaluations? Yes No (If so, please send a copy of the results.) HEALTH HISTORY Most recent exams (pediatrician, allergist, ENT, neurologist) Please describe: Child s present weight: Height: When/where has his/her hearing been screened? Pass/Fail: Any concerns? When/where has his/her vision been screened? Pass/Fail: Any concerns? We would appreciate having test results or any information your physician might wish to send us. Check the illnesses, injuries, and any surgeries your child has experienced. Give child s age and severity of illness. Please add others that your child has experienced, but which are not listed here.
Illness/Surgeries Age Mild, Average, Severe Hospitalization Date(s) Ear infection High fevers Croup Bronchitis Tonsillitis Allergies Seizures (convulsions) Chicken pox Scarlet fever Measles Mumps Reflux Injuries/accidents Tonsillectomy, Adenoidectomy Myringotomy/ Tubes inserted Other (please describe) Were there any noticeable changes in your child s speech immediately following any illness? If so, please describe:
In addition, please list any professionals to whom we may have permission to speak to during the application process for the purpose of receiving recent information: Name: Name: Phone: Phone: I give my permission for the Stepping Stones program to speak with the above named professionals if needed during the admissions screening process. Signed Date ADDITIONAL INFORMATION If there is additional information that you feel will help us to understand your child and his/her needs better, please describe below. Please continue on the back of this page if necessary. Thank you.
_ The Atlanta Speech School does not discriminate on the basis of age, race, gender, religion, or national origin in providing services to the public or in employment practices. More importantly, please note that the School requests this information consistent with the commitment in our mission statement to be a resource for our community. At the Atlanta Speech School, we seek to provide services to students, clients, families, and schools that reflect the people and cultures that make up the fabric of our city. The information you supply below will assist us in our efforts to meet this goal. Please check one or more of the boxes below that best describe the applicant s race and ethnicity. (Optional) Race: American Indian or Alaskan Native Asian Ethnicity: Hispanic or Latino Yes No Black/African American Native Hawaiian or Other Pacific Islander White More than one race Adapted from the U.S. Department of Education, Proposed Guidelines on Race and Ethnicity, 2006. Signature of Parent: Date: _ Please mail to: Atlanta Speech School Attention: Melissa Schmoker 3160 Northside Parkway, NW Atlanta, GA 30327
Stepping Stones Early Intervention Program Early Childhood Questionnaire Ages 2-5 years _ I. TO BE COMPLETED BY PARENT: Child s name: School: Birthdate: Grade: Teacher: My child is applying for services at the Atlanta Speech School. You have my permission to complete the following questionnaire, send the requested data and talk with the Atlanta Speech School regarding my child s performance. Signature of Parent: Date: II. TO BE COMPLETED BY TEACHER, DAYCARE PROVIDER OR NANNY: A. We are greatly assisted in evaluation and/or placement by comments and data from the child s school. Please help us by mailing to us as much of the following data as possible. This will be part of the child s Atlanta Speech School file and will be available to the parent. We appreciate your time and effort in gathering materials and completing this form. Please feel free to contact us by phone at 404-233-5332 if you have questions or comments. 1. Previous educational test data. 2. Reports and/or comments of previous and present teachers. 3. Progress reports from special programs such as speech therapy, physical or occupational therapies. 4. Illustrative samples of work such as art, printing, readiness materials, with explanatory comments. B. Do you have any concerns about this child? Yes No If so, what are your major concerns? Please return to: Atlanta Speech School, Attn: Melissa Schmoker 3160 Northside Pkwy., NW, Atlanta, GA 30327
Please check the following areas to help us better understand the child s performance level relative to the performance of others in the class. C. LANGUAGE Above Age Age Level Below Age 1. Listens and responds to speaker: 2. Follows oral directions: 3. Articulation of speech sounds: 4. Vocabulary usage: 5. Grammar usage: 6. Expresses self orally: 7. Contributes to group discussions: Comments: D. VISUAL MOTOR Above Age Age Level Below Age No Formal Exp. Choices 1. Colors within boundaries: 2. Cuts with scissors: 3. Draws simple shapes: 4. Writes first name: 5. Writes numerals to 10: 6. Writes alphabet letters: 7. Handedness established? yes right no left Comments:
E. BODY COORDINATION Above Age Age Level Below Age No Formal Exp. 1. Seems coordinated for loco-motor skills (i.e., running, skipping, etc.): 2. Balance: 3. Ball catching and throwing: Comments: F. MUSIC Above Age Age Level Below Age No Formal Exp. 1. Enjoys singing and related activities: 2. Remembers melodies and words: 3. Imitates simple rhythmical patterns: Comments: G. ART Above Age Age Level Below Age No Formal Exp. 1. Enjoys art activities: 2. Demonstrates appropriate control of crayons, paint brushes, etc.: Comments:
H. SOCIAL DEVELOPMENT Above Age Age Level Below Age No Formal Exp. 1. Executes self-help skills such as toileting, dressing: 2. Attention span in a group: (please comment below) 3. General organizational ability: (e.g. putting away toys, care of personal items) 4. Works independently: 5. Adjusts to new people/situations: 6. Tolerance for frustration/failure: 7. Interaction with peers: 8. Overall maturity: 9. If behavior is a concern, please attach an anecdotal record of behavioral observations: Comments: Describe typical classroom behaviors: What are the child s strengths?
Describe any concerns regarding this child: Describe the child s peer relationships: How does this child respond to behavioral interventions?: What techniques have you found to work best with this child? What techniques would you recommend be avoided? : If this child is experiencing any academic or behavioral difficulties, what insights do you have as to what might be at the root of this problem?
Is there anything else you think would be helpful for us to know regarding this child?: Please provide a brief description of your classroom environment. Please provide the number of students teachers within the class as well as overall structure of the program. _ Signed: School: Position: Phone: Address: Date completed:
_ Please mail to: Atlanta Speech School Attn: Melissa Schmoker 3160 Northside Pkwy., NW Atlanta, GA 30327