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Candidate Data:
First Name: 
Last Name: 

Date of Birth:









Broken Ground School



Guardian Info:

First Name:


Last Name:



16 East Side Drive, Apt 16




Guardian/Family Phone:

Guardian/Family Email Address:


Living Situation:


two parents but both work a lot

Financial Situation:



Free/Reduced Lunch:




How many live in the household?


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


Household Situation:

Octhinel's parents immigrated from the Conga and their first language is French, which is what is spoken in the home. Octhinel was born in the US and speaks English fluently. His parents work long hours to provide for the family, and, therefore, they are not at home when Octhinel gets home from school. He spends much/most of his day playing on electronic devices. He has an older brother with mental health issues and a history of substance abuse. Octhinel has a good relationship with his mother, but is somewhat shy/reserved with his father.

Organizations / Mentor Programs:

None that we know of

Special Assistance:

Octhinel has an IEP due to a Specific Learning Disability. He struggles academically and does not believe in himself. His teachers have tried numerous strategies to help get him engaged and motivated in school/academic work, but he continues to be disengaged. He gives up quickly if he is corrected and this impacts all subject areas. His teacher this year has tried to focus on positive reinforcement (not material objects) and more 1:1 time to build a relationship with him, and Octhinel took part in a structured CICO program for several weeks, but none of these supports have helped him engage. All these concerns have been shared with his parents (and the behavioral concerns, listed below), but they have not been able to nudge him in a positive direction, either.

Health Concerns:

He often complains about stomach issues but may be work avoidance; there are no medical diagnoses

Victim of Sexual Abuse:


Perpetrator of Sexual Abuse:


Victim of Physical Abuse:


Threatening or Aggressive Behavior:

He becomes verbally aggressive if he believes that a he or a friend are being threatened, but is seldom physically aggressive. The last time he was involved in a hands-on altercation was in third grade.

Required Physical Restraint:


Personality / Social Standing:

Octhinel is very extroverted and the others look to him as a leader, but he doesn't always provide a positive example. He likes to joke around with his peers and is generally well-liked. He has a strong self-esteem in terms of his social skills and social standing. Despite his social nature, he does not have a specific group of friends or best friend. Octhinel doesn't try to make others feel bad, but he doesn't consider others' feelings before speaking and will make jokes that insult others. In terms of how he responds to authority, Octhinel will sometimes say he doesn't care and other times cries when he gets in trouble. He will generally follow directions but it may take a while to do so. He doesn't like to admit when he has done something wrong (which leads to more story-telling, described below)

Behavioral Patterns:

The greatest concern staff have for Octhinel (besides his academic abilities) is his lying/story-telling. He makes things up constantly, without rhyme or reason and will lie about what he ate for breakfast just as readily as he will lie about being hands-on on the playground. He will alter events to make himself look better or innocent. At times, he has made up stories to get other students in trouble. He likes to "stir the pot" and will egg his peers on if he is not getting attention. Octhinel can be very defensive and is seen as having a "chip on his shoulder," believing that others are biased against him. He has done very little academic work this year.


Octhinel is in desperate need of a new setting where he can learn how to interact with others honestly and appropriately and learns that this is the way to make real, meaningful friendships (rather than just be the class clown). Students gravitate towards him and he thrives on their attention, but it hasn't led to good friendships. Just as importantly, Octhinel needs to be able to work hard at something, achieve a goal, and realize that he really can do hard things and feel the pride that comes from working through something that is difficult for him. His lack of faith in himself and the difficulty that he has at school means that he often gives up before he has started. He rarely tries his best. He needs a master course in developing perseverance and grit. What is most concerning, is that Octhinel has been demonstrating these kinds of behaviors and attitude/beliefs (about himself) since he started at BGS last year and despite all that has been done to support and encourage him, he is growing more disengaged in school and academics rather than improving.