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Candidate Data:
First Name: 
Last Name: 

Date of Birth:









Hanover Street School



Guardian Info:

First Name:


Last Name:



193 Hanover Street




Guardian/Family Phone:

Guardian/Family Email Address:

Living Situation:


Separated parents. Lives with Mom.

Financial Situation:


Free/Reduced Lunch:



How many live in the household?


How many work and/or provide income to support the household?


Household Situation:

Separated household, only child. Malachi has had access to horror and dark content from the age of 3. He spends the majority of his time with his Mother. The atmosphere is a best friendship with unclear boundaries. Child typically spends time indoors in a fixed position playing video games. Child is a toe walker and moderate refusal to participate in physical therapy (which is offered to him). Student is one year older than his peers.

If you interview, do ask about the relationship with bio-Dad.

Organizations / Mentor Programs:

None. This student reports barely leaving his home.

Special Assistance:

1:1 reading and writing support, physical therapy supports when he tolerates them. May benefit from social/behavioral goals but currently not on an IEP. Guidance visits are a tag-team with classroom teacher.
Just recently involved with Behavior support. At the present moment suspended for inappropriate use of computer including hate content including symbols and setting peers up for social failure.

Health Concerns:

Toe walking, limited food diet, lack of physical movement. Observed student during a workout time with his classroom and student lacked strength, muscular endurance or grit for perceived physical exertion.

Victim of Sexual Abuse:

Unknown, ask the Mother.

Perpetrator of Sexual Abuse:

Unknown to referrer.

Victim of Physical Abuse:

Do ask the mother.

Threatening or Aggressive Behavior:

Internet, social threats and aggression. Student spends time thinking of harming content and actions.

Required Physical Restraint:

Unknown to referrer. Not frequent or existent.

Personality / Social Standing:

The students personality is mysterious and dark. Child presents with an air of mystery, cunning, and mischief. Student can hold an age expected conversation with prompting. Speaks of gorry content that is inappropriate for his age. Interested in white supremacy, anti-Semitism, and disdain for anything beyond the sexual and gender binaries. The student interacts with his peers through humor, sometimes inappropriate for the age group or sets off other children, modeling unexpected behaviors both in-person and on the computer. He is more likely to listen to males in authority positions, but learning that females hold the power in social dynamics all the same. He is about 10% leader and 90% a passive participant in his own experience at school (introverted). His self-esteem is variable. Observed taking the school inclusion survey and answered questions with the general theme that differences in people are bad.

Behavioral Patterns:

He instigates and sets off his peers. Unsure that he has any trusting, long-term friendships. He does get along with his age-like peers and plays along at recess. He looks for opportunities to talk about violent and disturbing content.

When something is frustrating he shuts down and may eventually talk to a trusted adult (classroom teacher). He can try to charm through his humor which rarely works.


Strengths are his ability, when he trusts the adults to bridge gaps in his academic performance, social repair, and doing his best to walk (listening to "heals down" cue). He's a strong candidate as he has a challenging world view, self-concept, and bias towards dark/hate centric content leans him towards lack of engagement, diminished mood, and impulsive behaviors.