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Candidate Data:
First Name: 
Last Name: 

Date of Birth:









Henry McLaughlin Middle School



Guardian Info:

First Name:


Last Name:



1225 Bodwell Rd




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:

Logan lives in a two bedroom apartment with his mother and three sisters. Logan shares a small room with his three sisters. His sisters are 7 and 4 (the youngest girls are twins). Logan is not in any contact with his biological father and does not know him. Logan's stepfather, Chris, has been in Logan's life since Logan was an infant. Chris is currently incarcerated and will not be released from jail for four years. There was a lot of conflict between Mandy and Chris and Chris and Logan when they lived together, and Logan experienced trauma, emotional and physical abuse. Logan is on the Autism Spectrum and has been diagnosed with ADHD. He fights often with his sisters and spends a lot of time on his screens. He swears at his family members and is non compliant (he wants to be in control). He does help his mother with chores, though, and loves basketball. He also has an IEP and special education support. He takes medication for sleep, anxiety and ADHD.

Organizations / Mentor Programs:

Logan participates in the basketball program in the Derry Recreation Department. He and his family receive Intensive In-Homes support through FAST Forward's Wraparound program. He sees a therapist every two weeks.

Special Assistance:

Logan has an IEP to assisted with his reading and other subjects. He works with in the resource room with his case manager daily. He doesn't have a one on one aid.

Health Concerns:

No physical health concerns.

Victim of Sexual Abuse:


Perpetrator of Sexual Abuse:


Victim of Physical Abuse:

Logan was hit by and fought with his stepfather, Chris, when Chris lived with the family. He lived with them for 7 years.

Threatening or Aggressive Behavior:

Logan is verbally aggressive towards his sisters and mother and hits his sisters. He has hit his mother, an in-home counselor and the walls in the past when he got very angry.

Required Physical Restraint:

Yes, he has, by his mother, to stop him from hitting the walls and throwing things. This happened frequently in the past, but it has not happened recently.

Personality / Social Standing:

Logan does not spend time with friends outside of school. He can get along with others and has friends at school. He tends to be quiet in classes that he likes, but acts out if he doesn't like a class. At home, Logan spends a lot of time in the dark, on his screens, in his room.

Behavioral Patterns:

Logan will argue and get into fights with his sisters, but he blames them for the fights. He says he is fighting them because of something that they did wrong. Logan struggles with accepting limits in the home. He will swear at and fight with his mother. He resists showering at night and turning off his screens when asked.


Logan would greatly benefit from a positive male role model and mentor. He would benefit from getting out of the house and off his screens this summer. He would also benefit from playing sports with his peers and learning cooperative skills to build his self esteem. Logan struggles with accepting limits and his level of distress tolerance is low. He needs to learn prosocial coping skills for when he is angry or upset or anxious. He enjoys being outside when he is with his peers, but does not see them in the summertime.

Because he was in the home so much last summer, he fought a lot with his family. He cares a lot about his family, but the family's apartment is very small. This causes everyone stress because the kids do not have their own space. Because of Logan's Autism diagnosis, he gets overstimulated by having to share a room with his sisters. He also gets bored and picks on his sisters, which leads to conflict.

Logan works well with his special education case manager in school and responds to positively to her reward system of "Good Job Bucks." He has bought presents for his sisters with these bucks and says he likes the system. His favorite sport is basketball and he also likes to play on his X Box. He helps his mother and his grandfather when they need help with chores. Logan would benefit from the Mayhew Program because it would expose him to activities that he hasn't tried and enable him to make connections with a mentor and new peers.