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Our program is designed for individuals with mild to moderate intellectual and mental disabilities that may include, but are not restricted to, Autism Spectrum Disorder (ASD), Pervasive Developmental Disorders (PDD), Down Syndrome, Fetal Alcohol Syndrome (FAS), Fragile X Syndrome, Williams Syndrome, Cerebral Palsy, and other conditions associated with intellectual disability. Triform’s vocational training offers experience in sustainable community living including organic farming, organic gardening, weaving, pottery, home economics and landscaping. Our educational program offers classroom studies as well as art, music, drama, and movement. Our therapeutic residential community supports these young adults on their road to greater independence.

If you would like to schedule a tour & interview please fill out our Student Application Questionnaire and return it to our student admissions office .

Fee Schedule

Triform’s current annual fee for the 2024-2025 fiscal year for full time residential program is $72,950. Our 4-week trial visit fee is currently $7,500. The fee schedule may be subject to an annual increase based on the Board of Directors’ review.

Limited Financial Aid is available.

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STUDENT APPLICATION QUESTIONNAIRE

Date

YYYY

Print Name of Applicant

First Name

Last Name

Applicant's Date of Birth

YYYY

Print Name of Parent/Guardian

First Name

Last Name

Phone Number

(###)

###

####

Email Address

How did you hear about Triform?

Where and with whom does the applicant now live?

Current school placement and/or program?

When is placement needed?

Primary Diagnosis:

Secondary Diagnosis:

Seizures?

Yes

If yes, please describe:

Current medications:

Medication Name(s):

Current medications

Dose(S)

Current medications reason(s) for use:

Reason(s) for use

Current or past therapies:

Any special medical conditions we should know about:

Education history and experiences:

Describe Self-care and care needs:

Communication skills and needs (speech, hearing, vision):

Relationship to others, social skills and needs:

Relationship with children - Can the applicant live with and/or be around small children:

How does the applicant feel about animals - pets, insects, farm animals?

Does the applicant enjoy participating in group activities?

Describe level of sexual awareness including behavior disorders or problems, if any:

Has the applicant been assessed for abiltiy to consent to a relationship?

Relation to work (work interests, attitudes and habits, work tolerance, skills and limitations):

Response to direction when undertaking tasks:

Describe any hobbies, strengths, interests, special abilities, talents, and free time activities:

Orientation in space and time:

Idiosyncrasies, taboos, obsessions, fears?

Response to frustration and/or emotional distress?

Temper? Outbursts? Violence to self and/or others?

How are anger and frustration exhibited?

Are there other forms of antisocial or aggressive behavior?

Sense of danger?

Tendency to wander off or run away?

Has there been a Functional Behavior Analysis?

Has there been a Behavior Plan in place?

Is there or has there ever been a Fabrication Plan in place?

Tendency to fabricate stories about people, events or behaviors of others?

Able to read and write? Tell time? Use of telephone? Deal with money?

General health?

Sleep habits?

Please describe any difficulties or problems, if any:

Allergies?

If yes, please describe:

Yes

Special diet?

If yes, please describe:

Yes

Eating disorder/obsessions?

If yes, please describe:

Yes

Relation to food in general:

Please let us know any other relevant information that may help us to better know and understand the applicant:

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Fee Schedule

TRIFORM CAMPHILL COMMUNITY