Expression of Interest I CAN Network Online Mentoring 2022

September Program (Cycle #4) 2022 open for enrolment

If you would like your young person to do more than one group within a week, you will need to fill out the form twice, one for each group.

* This an EOI , NOT a registration form.

ONLINE GROUP MENTORING FAQs:

TECHNOLOGY REQUIRED: Access to a device that has both microphone and camera capabilities to access the Zoom platform.

COST: $285AUD for a 6 session program

NDIS: We can issue Self Managed & Plan Managed (Not NDIA Managed) families with an invoice. Families can also privately pay for the program.

AFTERNOON & EVENING PROGRAM DATES:

Afternoon programs start at 4.30PM- 5.30PM AEST

Evening programs start at 6.40PM-7.40PM AEST.

Spaces are limited and whilst we may not be able to offer every applicant a place at the current intake, you will be placed on the waitlist automatically and be contacted when a spot becomes available.

NEXT STEPS: Please note due to the volume of interest in this program, our first outreach to you will be when a space becomes available for your child.

For further details about our online group mentoring including start dates, please see the Key Program Details summary on our website https://icannetwork.online/online/

If you have any further questions, please email us at online@icannetwork.com.au.

All information submitted will be treated confidentially and with sensitivity.

Parent/Guardian Details

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Mobile

Parent/Guardian Email

About The Participant

Participant's First Name

Participant's Last Name

Please provide any further information you believe would help our staff in ensuring the participant has a well supported and positive experience.

Group Details

Has the participant been part of one of our online mentoring groups before?

YesNo

How did you hear about I CAN Network's online mentoring?

Please select the participants preferred communication method

Is the participant aware of their Autism diagnosis?

YesNo

Age groups are BROAD on the drop down menus to reduce selection option overload.

We will group participants CLOSE TO THEIR AGE BRACKET, please ensure you provide the correct age in the form.

As a guide we generally group within the following: 8- 13 years, 13-17 years & 17-22 years- this may vary in special interest groups.

I CAN Groups- 8-22 years old

I CAN Groups are designed for Autistic children, teens & young adults and cover numerous topics including but not limited to: self esteem, change, transitions, Autistic identity, self-care, relaxation, stress, strengths and many more topics that change on a rotating basis. These groups offer a safe space for participants to connect with peers who they can relate to due to shared experiences.

I CAN IMAGINATION CLUB-8-13 years old

I CAN Imagination Club® offers a safe, engaging environment where Mentees are encouraged to recognise and celebrate their own strengths. Participants do not need a diagnosis of any sort in order to join and benefit from the I CAN Imagination Club®. They are invited to take part because of their ‘big imaginations’ and we do not explicitly discuss Autism. All topics will be covered in an age-appropriate way and may include but are not limited to: belonging, self-esteem, self-care, social groups, interests, sensory needs, change and transitions. This is most suited to those in their primary school years.

I CAN Special Interest Groups (Varied)- 8-22 years old

I CAN Special Interest Groups are designed for Autistic children, teens & young adults to connect to peers and mentors with the same special interest and share these passions and shared experiences with others in a safe and fun environment. The content will be based on the special interest chosen and the content changes on a rotating basis to cater for ongoing participation across the year.

I CAN LGBTIQA+ 13-22 years old

I CAN LGBTIQA+ is designed for Autistic teens and young adults who identify as LGBTIQA+ (including those who are questioning). This group offers a safe space for participants to connect with peers and mentors who can relate and explore topics including, but not limited to: Autistic & Queer identity, pronouns, Queer culture, belonging,gender, sexuality, social connections, self-care, emotion regulation and sensory needs.

Note: There is no game playing via servers in the Roblox, Minecraft, Dungeon & Dragons, Gaming groups, the content is themed around these interests.

Please select your first preference of group to enrol your participant in, when a spot becomes available

Please select your second preference, as we may not be able to offer your first preference.

Is there any else you would like to let us know?

Thank you for expressing your interest in our Online Mentoring Program.

If you have any questions, please email us at online@icannetwork.com.au

Date Submitted (Day/Month/Year)

Contact ID

Enrolment ID

Government	Catholic
Private/Independent	Government Distance Education
Independent/Private Home School

Anxiety	Depression
Self-harm	Suicide attempt
Suicidal thoughts	Dyslexia
ADD/ADHD	Intellectual Disability
Global Development Delay	Tourettes Syndrome
Borderline Personality Disorder	Bipolar
Eating Disorder	Obsessive Compulsive Disorder
Oppositional Defiance Disorder	Colour Blind/ Vision Impairment
Other- Please indicate in text box below