CASES Study Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.1Student Information2Parent information3Information about the student's statusStudent nameBirth dateChronological ageNationalityGenderfemalemaleNextFather's nameFather's jobFather's phone numberMother's nameMother's jobMother's phone numberThe emirateAbu DhabiDubaiSharjahAjmanUmm Al QuwainRas Al KhaimahFujairahRegionEmailEmergency phone numberPreviousNextMedical historyThe student's health condition is generally not goodThe duration of pregnancy was abnormal (9 months).The student was exposed to problems immediately after birthThe student’s developmental history was abnormal (crawling, sitting, walking)The student suffers from congenital problems (internal or external)The student suffered from a lack of oxygen during birthThe student stayed in the hospital for a while after giving birthThe student suffers from problems with sight, hearing, or touchThe student suffers from breathing problemsThe student suffers from contagious skin diseasesThe student suffers from epilepsy or seizuresThe student suffers from movement problemsThe student suffers from eczemaThe student suffers from any allergy to food, drinks, or anything elseThe student has problems sleepingThe student suffers from a lack of control over excretion (urine - feces).The student is taking any medical medicationsSelf careThe student struggles to go to the bathroom on his ownThe student struggles with how to ask for the bathroomThe student struggles with using signs or pictures to ask for the bathroomThe student struggles with wearing a diaperThe student struggles to get dressed on his ownThe student struggles to undress on his ownThe student struggles to wear shoes or socks on his ownThe student suffers from taking off his shoes or socks on his ownThe student struggles to close the zipper on his ownThe student struggles with buttoning on his ownThe student struggles to wear pants on his ownThe student struggles with washing his hands and face on his ownThe student struggles with brushing his teeth on his ownThe student suffers from using a towel or handkerchief (tishu) on his ownThe student struggles with combing his hair aloneThe student struggles to prepare food on his ownThe student struggles with eating aloneThe student struggles to eat and drinkOther termsWhat hand does the student use? RightLeft What hand does the student use?RightWhat hand does the student use? RightLeftWhat hand does the student use? Left What are the student’s favorite rewards?DessertChipsElectronic screensOther reinforcementsOther reinforcementsSensory disturbancesThe student suffers from frequent hand flappingThe student suffers from walking on the tips of his feet frequentlyThe student suffers from excessive sensitivity to loud soundsThe student suffers from paying close attention to weak and monotonous soundsThe student suffers from a passion for lightsThe student experiences discomfort from physical contact such as huggingThe student experiences discomfort from physical contact such as huggingThe student suffers from not wanting to wear clothesThe student suffers from looking at things sidewaysThe student suffers from bringing objects closer to the eye and staring at themThe student suffers from a fear of swinging or rapidly rotating toysThe student suffers from harm to himself or othersThe student suffers from making incomprehensible sounds and tonesThe student has difficulty chewing foodThe student has difficulty swallowing foodThe student suffers from hypersensitivity to strong odorsThe student suffers from exaggeration in smelling all thingsThe student suffers from eating things that are not intended for eatingThe student suffers from stereotypes and daily routineThe student suffers from a lack of fear of risksSpeech and language disturbancesThe student does not have the ability to tell a complex storyThe student does not have the ability to tell a simple storyThe student has no ability to deduceThe student cannot form a sentence of 4-5 wordsThe student cannot form a sentence of three wordsThe student cannot form a sentence of two wordsThe student cannot pronounce a single wordThe student cannot repeat sentencesThe student cannot repeat wordsThe student cannot repeat soundsThe student cannot understand a three-word sentenceThe student cannot understand simple commands such as (stop - sit - come)The student cannot understand compound commands such as (bring a pen and color with it)The student cannot express what he wants through a sentence of three wordsThe student cannot express what he wants through single wordsThe student cannot express what he wants through body language and gesturesThe student cannot know his name when asked, “What is your name?”The student cannot find out his address and phone number when asked about thisThe student cannot make eye contact with the speaker for 5 consecutive secondsThe student cannot pay attention when his name is calledThe student cannot distinguish one sound from several overlapping soundsThe student cannot pay attention to anything heard or seenBehavioral problemsThe student suffers from ADHDThe student suffers from attachment to electronic screensThe student suffers from stubbornness or failure to obey ordersThe student suffers from aggression and love of violenceThe student suffers from throwing things on the groundThe student suffers from throwing himself on the groundThe student suffers from vandalizing and breaking thingsThe student suffers from thumb suckingThe student suffers from spitting on othersThe student suffers from the behavior of biting himself or othersThe student suffers from any sexual disordersThe student suffers from excessive crying and screamingThe student suffers from exposing his private parts in front of othersThe student suffers from the inability to express the need to use the bathroomThe student noticeably suffers from talking to himselfThe student suffers from fear of strangers, animals, or othersThe student suffers from a fear of heights, elevators, or anything elseThe student suffers from being isolated from othersThe student suffers from a lack of perseverance in performing tasksThe student suffers from binge and voracious eatingThe student suffers from a lack of desire for foodThe student suffers from taking things (that he does not have the right to) without asking for permissionThe student suffers from constant lying and arguingThe student suffers from nail bitingThe student suffers from bullyingThe student suffers from severe mood swingsThe student suffers from dependence on othersThe student suffers from excessive jealousyLearning disabilitiesDoes not have the ability to continue performing the task or activityHe does not have the ability to concentrate and pay attentionHe finds it difficult to understand instructionsHe finds it difficult to carry out instructionsHe finds it difficult to read in generalHe finds it difficult to perform calculationsHe finds it difficult to write words correctlyHis linguistic vocabulary is very limitedHe does not have the ability to follow the class discussionHe does not have the ability to copy information correctly from the book or blackboardHe finds it difficult to apply what he has learnedReflects letters and numbers when reading and writingHe is constantly late in turning in his schoolworkHe needs more time to learn new tasks than his colleaguesUnable to remember the printed wordHe finds it difficult to recognize letters and numbersHe finds it difficult to distinguish sizesHe finds it difficult to distinguish (right - left - up - down)He has poor auditory memoryHe has difficulty distinguishing auditory stimuliHis motor coordination in general is very weakHe has poor visual memoryHis ability to use his hands is very weakThe student's strengths from the parents' point of viewBasic points of need from the parents’ point of viewGuardian's signatureClear SignatureParagraph TextDear honorable families, We thank you for your willingness to participate in the professional interview dedicated to clarifying the working hours and our programs that suit your dear child. Please note that the duration of the interview will be 15 minutes, and during this time the following matters will be addressed: 1. Definition of manager: - The manager will introduce himself by mentioning his name and profession to create a comfortable and transparent environment. 2. Specific items: - The items you selected in the form that we would like to discuss will be presented. - Matters of common interest and the need to understand how our programs fit the needs of your precious child will be reviewed. 3. Inquiries and clarification: - The manager gives you the opportunity to ask any questions or request clarification regarding the system or programs. -We will be happy to provide any additional information you may need. Interview objective: Our goal in this interview is to clarify the working hours and our programs that are compatible with the needs and aspirations of your honorable child. Please keep in mind that this interview is not for the purpose of evaluating the student, but rather to provide the necessary information to ensure an effective and comfortable learning experience for our children. We appreciate your understanding and cooperation, and look forward to meeting you at the interview. Sincerely, Genius Factory Academyتقديم
