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Home
About the Program
How it Works
Resources
Contact
Create a Digital Blue Envelope
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Name
My name is
*
I like to be called
Communication and Interaction Needs
Communication Ability
*
Verbal
Limited Speech
Non-Verbal
Uses AAC Device
Other
If other, please specify
Processing and Understanding
*
Needs extra time to respond
May not respond to verbal commands immediately
May avoid eye contact
May repeat words or phrases
Other
If other, please specify
Best Way to Communicate With Me
Example: Speak calmly, give one instruction at a time, allow 10–15 seconds to respond.
Sensory and Safety Needs
to My Responders
Sensory Triggers or Things That May Cause Distress
Example: Loud noises, bright lights, being touched unexpectedly, crowded spaces.
Important: Things Responders Should Avoid
Example: Do not grab suddenly, do not shout, avoid flashing lights when possible.
Emergency Contact 1
Name
*
Relationship
*
Phone
Emergency Contact 2
Name
*
Relationship
*
Phone
Submit
