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Candidate Data:
First Name: 
Last Name: 

Date of Birth:









Weston Elementary School



Guardian Info:

First Name:


Last Name:



82 Karatzas Ave

Apt 201




Guardian/Family Phone:

Guardian/Family Email Address:


Living Situation:


William lives primarily with his mom and 2 younger sisters. Mom also has a roommate. William does have some visitation with his dad, but I am unsure how consistent his visitation is and his dad is not listed as an emergency contact for school.

Financial Situation:


Free/Reduced Lunch:




How many live in the household?


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


Household Situation:

William lives primarily with his mom and 2 younger sisters. Mom also has a male roommate that she is not in a romantic relationship with. In the stories William has told about his family life, it seems that mom has a trauma history and medical issues. When William describes his mom's roommate, he says that the roommate mostly plays video games and doesn't help much around the house, although will sometimes cook dinner for him and his younger siblings if their mom is out. William frequently complains about being tired because he stays up late playing video games with the roommate. William does have some visitation with his father, but does not talk about him with any consistency other than mentioning that he planned to see his dad for Christmas.

Organizations / Mentor Programs:

None that I am aware of.

Special Assistance:

William is not currently identified under IDEA, although he is academically below grade level. He semi-regularly sees our behavioral health counselor (he does not have any behaviors, but was new to our school last year and struggled to make friends).

Health Concerns:

None that I am aware of.

Victim of Sexual Abuse:


Perpetrator of Sexual Abuse:


Victim of Physical Abuse:

Not that I am aware of, but William dose report that his mother has been shot before.

Threatening or Aggressive Behavior:


Required Physical Restraint:


Personality / Social Standing:

William is a quirky kiddo who loves to chat once he opens up (he is currently reading the Harry Potter series if you're looking for an ice breaker). He has a small group of friends at school, and hangs out with one of them outside of school sometimes (they live in the same apartment complex). He is a bit socially awkward, and could be susceptible to peer pressure, but is not aggressive or maladaptive. He can be a bit defensive at times, but is overall a fairly easy kid to work with.

Behavioral Patterns:

In general, William is fairly well behaved. He could benefit from some growth in the areas of motivation and responsibility as well as study skills and motivation. He sometimes struggles to initiate and stay on task or consistently turn in homework. He is not very boastful although sometimes I think he skews the truth negatively at times due to low self-esteem, which is unfortunate because he sees the world a bit differently and his unique perspective could probably be used to invent something really cool.


William a kid who has to entertain himself a lot at home. He has a lot of creative ideas - inventions, etc. but actually spends his time on videogames instead of outside. This is likely due to the fact that he lives in an apartment complex. He had one friend he would play with often and that boy moved out of the country.

When we first met William a little over a year ago, he was extremely quiet and shy, but he has come out of his shell a lot this year as he has been paired with a number of children to spend time with at school. His self esteem has improved as he has been able to show other students how good he is at basketball - something no one knew since he did not try out for the team. His teacher reports he tries very hard in school and is showing an interest in STEM

In addition to this, William is polite and respectful to adults. It would be great to see him gain confidence in himself and to be able to join in with others on his own initiative. He has lots to offer and some positive modeling and skill building would really allow him to thrive.