I use this document with clients in college to help them examine their needs in the classroom. Additionally, I encourage clients to use this as a personal and practical introduction to their instructors, either in person or via email.

I suggest that clients include only the information they feel comfortable sharing and to complete independently or with academic advisor.

I completed the example below with an imaginary student.

____________________________________________________________________

Name: Susie Q
Class: Introduction to Modern World History

My Special Interests:
Rocks
Cooking from recipes

Strengths:
Rote memory
Sense of humor
Story-telling ability
Expressing my needs

Challenges:
Group projects
Talking about topics not interesting to me
Controlling my volume
Long-term projects
Asking for help

Anxiety Triggers:
Changes in routine
Changes in personal space
New social situations
Interruptions when I am talking

Signs of My Anxiety:
Play with my hair
Pace
Fidget with nearest object
Volume increases
Difficulties maintaining train of thought

Adaptations: Curricular and Environmental
Visual supports enhance auditory presentation of material
Short breaks as needed
Sit away from distractions, including distracting peers
Voice record lectures
Choice to independently complete group projects

Organizational Support Needs:
Graphic organizers to aid note-taking
Lists to reinforce the correct order of steps or activities
Complete list of expectations for all assignments

Social Support Needs:
Index card with conversation starters
First choice picking group partners

Sensory Support Needs:
Fidgets: bracelet, ring, slinky
Adequate and appropriate space to walk around

Impossible Tasks for Me:
Presenting in front of a group
Calling anyone on the phone

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