We do our best to ensure that Beyond Akeela will be a great fit for your teen. To help us in this effort, please be as open and honest as possible as you answer these questions. We recognize you may not be able to complete this in one sitting, and you are able to save and return to the form by clicking the “Save & Resume Later” link at the bottom. Please don’t hesitate to reach out with any questions!

Camper Name: *

Camper's Current Grade: *

Parent Name: *

We are most likely interested in: *

• First Session
• Second Session
• Flexible or unsure

1. It's typical for teens to feel uncertain about attending Beyond Akeela for the first time. Participating in this application process, watching videos, and reviewing our website will hopefully help! Once teens arrive at Beyond Akeela, they have to be motivated to participate in the program, including less preferred activities. As things stand today, what are your teen's feelings about attending the program? How motivated are they to attend? *

2. Has your teen ever attended camp? Have they spent the night (or longer) away from home? What was that experience like for them? *

3. What would make this summer a success for your teen? What do you hope they accomplish at Beyond Akeela? *

4. Is your teen engaged in conversations about their post-secondary future (ie. college plans, potential jobs, etc)? What are their goals beyond high school graduation?

5. What are your teen's favorite activities at home, at school and in the community? *

6. How would you describe your teen's interactions with their peers? How do peers respond to them? *

7. What situations (socially or otherwise) are particularly challenging for them to navigate? *

8. Successful Beyond Akeela teens can navigate camp life (eg. hygiene, social emotional relationships, participation) without consistent 1:1 support from a staff member. What coping skills/strategies is your teen able to implement in challenging moments? *

9. What type of adult support does your teen need to regroup and rejoin after a difficult moment? About how much time is this support typically needed? *

10. How frequently is this support necessary (eg. daily, weekly, monthly)? *

11. How does your teen respond to requests from parents/guardians and teachers? (Ie. How well do they follow rules and expectations?) *

12. Does your teen have a history of verbal or physical aggression, destructive or self-injurious behavior? If so, please describe the circumstances, frequency and how long it's been since you have seen this behavior. What have been the most effective interventions? *

13. To help us create an environment that provides better social outcomes, we do not allow cell phones, tablets, or video game devices at camp. Campers can bring music players or eReaders for use during downtimes. How do you think your teen will do without their cell phone for the duration of camp?

14. What special services, if any, does your teen receive at school (e.g. academic support, speech/language, social/emotional support)? *

15. Many teenagers who struggle socially have also been diagnosed with a mental health disorder (e.g. anxiety, depression, mood disorders). Please share with us any mental health needs that your teen may have. *

16. What, if any, special health, hygiene, or dietary needs (including allergies) does your teen have? *

17. Is there anything else you'd like us to know about your teen?

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