Screening

Please complete the form below to apply to be on Emerald Coast Learning Center’s waitlist.

Are you interested in learning more about Emerald Coast Learning Center for private school services? *

Gender *

Is student vocal? *

Augmented Communication Device? *

Potty trained? *

Describe maladaptive behaviors

Briefly describe student's communication abilities

Eligible for FESUA? *

Do they have insurance covering ABA in case 1:1 services are needed in clinic? *

Additional Notes