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Candidate Data:
First Name: 
Last Name: 

Date of Birth:









Penacook Elementary School



Guardian Info:

First Name:


Last Name:



285 Redwood Rd.

Loudon NH



Guardian/Family Phone:

Guardian/Family Email Address:

Living Situation:

Single Mother

Financial Situation:



Free/Reduced Lunch:




How many live in the household?


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


Household Situation:

Alec currently lives in a household that consists of his mother and a younger brother. Alec's younger brother has health issues that Alec often worries about. Alec's mother works nights. Alec's mother is young and is trying to provide for her family and take care of both boys. It seems that her responsibilities leave her feeling stressed and her interactions with Alec can come across in a curt tone and leaving Alec feeling like things are his fault or he has done something wrong a lot of the time. Alec does have limited visitation with his father, a couple of times a month. His father is not listed in our school information and we are not sure what type of a relationship that they have.

Organizations / Mentor Programs:

YMCA Kydstop after school program. Alec also has participated in karate.

Special Assistance:

Alec has an IEP. His issues have stemmed more from an emotional behavioral level. He was originally at Loudon Elementary School in kindergarten. His behaviors in school became such that he was referred to the Learning and Adjustment Program at Penacook Elementary School, which is a specialized program for students with behavioral issues. He would frequently leave the classroom when in Loudon. At Penacook Elementary he would have individualized check-ins throughout the day, which helped pretty quickly. He was able to be integrate back into his regular classroom. He does still require some type of a behavioral plan, the plan that he has been using this year seems to be working well for him. Alec is one that tries to avoid things that are uncomfortable for him and when his plan is not working he will frequently be asking to leave the classroom and then wander the halls. Alec also has used language in the past like "I should just go kill myself" when feeling frustrated in a classroom. After processing his statements with him, it seems that Alec uses this type of statement when feeling like something is challenging and he lacks the self-confidence to try. When asked if he really feels like he wants to kill himself he will answer 'no'. When he has a positive relationship with the adult in his classroom and a positive behavior plan he is able to maintain in the classroom. He seems to respond well to clear expectations and boundaries.

Health Concerns:

Alec has a history of a seizure disorder. He has a seizure first aid plan that is kept with the school nurse. HIs mother reports that he has been off of his seizure medication for a couple of years now and has been doing well. He does have asthma so would be bringing an inhaler with him. He also has a form of muscular dystrophy that may slightly affect his mobility, he does not require braces or anything to help him with this.

Victim of Sexual Abuse:

It does not appear that Alec has any history as a victim of sexual abuse.

Perpetrator of Sexual Abuse:

Alec does not have a history of perpetrating any sexual abuse.

Victim of Physical Abuse:

We are not aware of any physical abuse for Alec.

Threatening or Aggressive Behavior:

Alec can be verbally aggressive to his teachers at times. He did pick up a stool and held it over his head once but did not throw it and was able to calm down and leave the classroom to process what was upsetting him.

Required Physical Restraint:

Not to our knowledge. The safety issue that was the biggest concern when he was younger was that he would elope from the classroom. Occasionally, Alec will leave the classroom now and wander the halls if there is something going on in the classroom that he wants to avoid.

Personality / Social Standing:

Alec seems to be introverted. He often struggles with social interactions due to not having common interests with his peers. He seems to have low self-esteem and lacks the confidence to make lasting connections. He wants to make friendships and can interact well with peers with some guidance. Alec responds best when he feels he is being listened to and he has the chance to build positive relationships with the authority figures around him. Providing that he has established these positive relationships, he responds well to clear expectations and boundaries. He may be willing to take more risks if he knows there is someone that he has begun to trust there helping to guide him through more challenging situations.

Behavioral Patterns:

Alec can be nervous in new situations and either become emotional (crying) or shut down and not talk if he is in a circumstance that is making him feel uncomfortable. He tries to avoid being uncomfortable. He can be set off by peers and become vocal about what he is finding annoying, thus annoying those around him. He can walk away and not want to take ownership of his actions, blaming others for his behavior.


It is our thought that Alec could really benefit from being a part of the Camp Mayhew Program because he has lacked the positive support from the adults in his life. It would be wonderful to seem him in a situation where he feels positively connected to those around him and can grow and learn what he is capable of doing. Alec is very interested in animals, specifically cats. Alec is also a very good artist and has a talent for drawing. He can be very kind when in a situation where he feels safe and comfortable. It would also be wonderful for him to have something special in his life that is just for him. The idea of having a mentor that would be there to check in with him throughout the year and the opportunity to go back to camp is something that we think could really give Alec the boost to have the confidence to make great decisions for himself in the future.

*Mom does receive assistance with day care costs for both children.