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Candidate Data:
First Name: 
Last Name: 

Date of Birth:









Dover Middle School



Guardian Info:

First Name:


Last Name:



18 Pleasant View Circle




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:

Curtis is very close with his mother. The two of them live alone in public housing in Dover. Curtis' biological father is not in the picture, but there is an ex-boyfriend of mom's that he stays in contact with and refers to as his dad. The family receives public assistance as Christine does not work. Christine cares about Curtis a tremendous amount and is open to support for and conversation about Curtis.

Organizations / Mentor Programs:

None at this time.

Special Assistance:


Health Concerns:


Victim of Sexual Abuse:

None that we know of.

Perpetrator of Sexual Abuse:


Victim of Physical Abuse:

None that we know of.

Threatening or Aggressive Behavior:


Required Physical Restraint:


Personality / Social Standing:

Curtis is a very kind kid. He loves his mom and often goes out of his way to help her out. Curtis has a pet cat named Gizmo that he adores. He also has a tank of fish he cares for and is very interested in learning how to garden. This winter he has raised a plant from seed that he is quite proud of. Curtis is shy at first until he opens up to new people. He often needs a little push to get started with new things. His mother describes Curtis as a follower. He doesn't have much confidence in himself and often second guesses his decisions and actions.
Curtis gets along fairly well with peers. He doesn't have many friends, but those he does have have been around for a while. Curtis is respectful with his teachers and has developed a relationship with myself. By his choice, we Zoom twice a week to check in. He is always on time and eager to participate in any activity I have going on.
Likes video games, camping, his cat, growing plants, family, camping

Behavioral Patterns:

Curtis' lack of confidence and lack of belief in himself seems to get in his way more than anything else. Curtis shows up for virtual classes every day, but doesn't put a whole lot of effort into the work. His teachers like him, but believe he has more potential than he is putting forth. His mom and I agree Curtis has the ability to be a positive leader, if he can develop his confidence. He's afraid to try new things, but once he gives it a shot, he will give it his all.


Kind, loveable, outgoing, smart, patient
Can get down on himself, will call himself stupid.

Curtis is well behaved and doesn't like to rock the boat. He gets along reasonably well with peers, and has developed a relationship with a few. He is a middle of the road student, with potential for more. When overwhelmed, Curtis can break down and get upset, but he does rally and with encouragement, will try again. Curtis seems to be a small group kid, and would rather have a couple good friends than a large group of acquaintances. He is not super athletic, though does like to play outside when he's able. Personally, I really enjoy Curtis and believe with appropriate guidance he will be able to learn about and make healthy choices for himself. The first step, however, I to develop the confidence to take that step.