Beyond Autism — A Collaborative Approach
The Hive

Prospective Member Intake Form

Thank you for your interest in The Hive! Please complete the following information to help us learn about the prospective member, their interests, and support needs.

Member information

Parent / guardian / primary contact

Legal guardian (if applicable)

DDD & program information

Is the prospective member currently receiving DDD services?
Which DDD services is the prospective member currently authorized to receive? (select all that apply)
Does the prospective member currently have an approved Enhanced Staffing Ratio (ESR) through DDD?
If yes, what staffing ratio is approved?
If an ESR is not currently approved, do you believe the prospective member requires additional staffing support?

Health & medical information

Does the prospective member have any allergies (food, medication, environmental)?
Does the prospective member take medications?
Will any medications need to be administered during program hours?

Personal care & daily living

Does the prospective member require assistance with (select all that apply)

Communication & support needs

How does the prospective member primarily communicate?
Does the prospective member require (select all that apply)

Interests & preferences

Signature