Dub-C Autism Program (D-CAP): Parent Questionnaire

Dub-C Autism Program (D-CAP)

Cherie Fishbaugh MA, BCBA, BS-L (PA)
Director of Autism Services
20 Linden St.
West Chester, PA 19383
CFishbaugh@wcupa.edu
610-436-3168

Phone:

- Phone (next 3 digits) - Phone (next 4 digits)

Student's major at WCU:

Why did student pick major?

Please describe the student's dream job:

Students' Work Experience

Please make sure you have filled in all required fields with valid information.

Has the student been in a working environment?

Employed Volunteered N/A

Where were they employed? Where did they volunteer?

What were the duties at the job?

What, if any, were challenges in the work environment?

Has the student been in a working environment?

Employed Volunteered N/A

Where were they employed? Where did they volunteer?

What were the duties at the job?

What, if any, were challenges in the work environment?

Has the student been in a working environment?

Employed Volunteered N/A

Where were they employed? Where did they volunteer?

What were the duties at the job?

What, if any, were challenges in the work environment?

All things have a place
Some things have a place
Nothing has a place

Clean
Have clean areas
Need to dust/vacuum/wash

Quiet
Normal volume
Loud

Have a schedule for chores/housekeeping
Have a schedule for some chores/housekeeping
No schedule for chores/housekeeping

Like a majority of time to be private/alone
Like 50% of time to be private/alone
Prefer to be around others in house/living arrangement

How does your student respond when they are very afraid?

What are the student's coping strategies when they are very afraid?

How does your student respond when they are very anxious?

What are the student's coping strategies when they are very anxious?

How does your student respond when they are very frustrated?

What are the student's coping strategies when they are very frustrated?

Any additional information you wish to share: