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Candidate Data:
First Name: 
Last Name: 

Date of Birth:









Pleasant Street School



Guardian Info:

First Name:


Last Name:



29 Merrimac Street Apt 1




Guardian/Family Phone:

Guardian/Family Email Address:


Living Situation:


Mother and Step Father

Financial Situation:



Free/Reduced Lunch:






How many live in the household?


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


Household Situation:

In Skyler Moore's 12 year life, the first five years of his life were very chaotic as well be evidenced in this referral. In 2014 his aunt took over as a caretaker and consistency has been more the rule than the exception. Skyler lived with his mother, Angela, who had custody of him until he was two years old. When Skyler was two years old his biological father took him for the week so mom could get settled and his dad filed for custody. His father and his girlfriend were very abusive to Skyler. His father left him with an underaged person with no food and clothes so mom had to go pick him up. At this time Angela’s mother took temporary custody. In 2014 Skyler's grandmother passed away and his aunt Melissa became his caretaker. He did not see his father at all during this time but Angela stayed connected as much as she could. In the summer of 2020 Angela communicated with Melissa that she was ready to care for Skyler again. His sister Arianna is still with Melissa. He has several other half siblings that he does not see often but knows about them. Skyler currently lives with his mother Angela, Stepfather Richard and his sister Jade. Skyler gets along well and has a positive relationship with all family members.

Organizations / Mentor Programs:

Health First therapist had him apply to Magnified Voice.

Special Assistance:

Skyler has an IEP for speech. He does not receive regular guidance visits and used to have a one on one but doing better now and does not.

Health Concerns:

Skyler has an appointment with neurology coming up. He is diagnosed with Lyme disease. His hearing and vision is drastically declining. He is also diagnosed with anxiety and ADHD and currently takes prozac, melatonin, and focalin.

Victim of Sexual Abuse:

Skyler was sexually abused by his cousin when he was two. DCYF was notified.

Perpetrator of Sexual Abuse:

Skyler does not have a history of being a perpetrator of sexual abuse.

Victim of Physical Abuse:

Skyler was physically and emotionally abused by his biological father, his girlfriend and Angela's step brother. Skyler would be kept locked in a room alone and was hit. Angela's has called the police when witnessing this. DCYF was involved numerous times when Skyler was with his father.

Threatening or Aggressive Behavior:

Skyler has not had any threatening or aggressive behavior towards himself or others.

Required Physical Restraint:

Skyler has never required physical restraint.

Personality / Social Standing:

Skyler is a heart of gold and very caring. He loves sharing and helping others. He is always eager to learn and try new things. He loves to make friends and if he sees someone who is lonely he will help bring him into his friends group. He is a compassionate soul. He is sometimes a leader and sometimes a follower depending on the situation. He has the capability to be a leader when he is comfortable in a situation and feels confident. He loves school. He responds well to authority and listens to adults even when he doesn't want to.

Behavioral Patterns:

At a young age, the important males in Skyler's life continually criticized and belittled him. As a consequence of this he has both low self esteem and negative self efficacy. He default setting is "I can't do it, I am not good enough." Angela continues to tell him to believe in himself. If someone is bullying him he will not say anything because he doesn't want to get that person in trouble. He doesn't want anyone to be mad at him. He does not get in fights or boast about his abilities. He does the opposite.


Skyler is very curious, kind and loving. He has compassion for others and really loves trying new things and Mayhew would be the perfect place for this. Angela wishes that Skyler could have more confidence in himself but feels he is scared to. Skyler's stepfather, Richard Littlefield, went to Mayhew as a boy between 1996-1998. Skyler's family understands the impact that Mayhew can have on a child and is very hopeful that Skyler can have this same opportunity. Mayhew will offer Skyler the opportunity to develop trusting relationship with males both his own age and adults that will help him develop a clearer sense of his own identity. Inside of this boy is a heart ready to explore and have adventures. Summers out on the island can help heal the early damage that was done to his self esteem and can build this young man into the future he deserves.