All About Me Form: Adult

This is a form to be filled in with important information about an adult self-advocate. When complete, the form includes information including the person’s name, communication preferences, likes, dislikes, and important contacts’ information. This can then be a useful tool for efficiently and effectively providing an individual with support.

 

All About Me Adult Form

Fill in the following information about demographic information about yourself:

My Full Name, My Nickname, My Birthdate

Fill in the following information about your communication preferences:

How do I communicate?, Commonly used language, terms or phrases I say and what they mean, Go to phrases I use and what they mean

Fill in the blanks for the top things to know about you:

My favorite things (people, foods, clothing, TV/movies, music, hobbies, high interest topics, etc.), Things I don’t like (certain people, being touched, weather, sounds, words/phrases, babies, color yellow, clothing, etc.), Things I’m afraid of, Things that might make me upset, Things that help me calm down (songs, books, movies, items, places to go to calm down, etc., How to introduce me to new people/items/locations etc.

Fill in your important contacts:

Important Family/Friends Contact Information, Supports Coordinator/Case Manager/Support Staff Contact Information

Fill in important medical information about yourself:

Primary Care Doctor Contact Information, Psychiatrist/Specialist Contact Information, Medications/Dosages Being Taken/What are they for

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This information was developed by the Autism Services, Education, Resources, and Training Collaborative (ASERT). For more information, please contact ASERT at 877-231-4244 or info@PAautism.org. ASERT is funded by the Bureau of Supports for Autism and Special Populations, PA Department of Human Services.