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Intake and Comprehensive Assessment Form

Thank you for your interest in Autism Sanctuary’s day program!


This intake and assessment form will ask the following information about the applicant (i.e. person in need of services): biographical, psychosocial/demographic, medical, nutrition, behavioral, and current abilities.


PLEASE NOTE: you must upload the following files at the end of the form if applicable: most recent/current Individualized Services Plan (ISP); most recent/current Behavior Intervention Plan; and most recent educational and/or psychological evaluations from within the last 2 years. The application will not be considered to be complete if these documents are not submitted when applicable.

Our team will review your application and attached documents as swiftly as possible. Once reviewed, a member of our team will contact you to set up a time to meet in person for an intake appointment. Should you have any questions, please contact the Director of Applied Practice, Casey Clarke, by emailing


2860 Pea Ridge Road, Charlottesville, VA 22901


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