Momentum - Momentum Kickoff Form

Hello! What brings you here today?*

First Name*

Last Name*

Primary Email*

Primary Phone*

What state do you live in?*

What is your current occupation?*

Please list occupation

What assessment tools do you have working knowledge of?*

Reinforcement inventory

Functional Assessment Screening Tool

Contextual Assessment Interview

Functional Assessment Interview

ABLLS or ABLLS-R

VB-MAPP

AFLS

Skillstreaming Curriculum

ACE

EFL

PEAK

Vineland Adaptive Behavior Scales

Other

What other assessment tools would you like to list?

How many consecutive years have you been a practicing BCBA?*

Do you have any ethical violations against you by the BACB (or any pending)?*

Are you eligible to supervise RBT's?*

Have you managed other people outside of your clinical role as a BCBA (e.g., clinical director/supervisor)?*

Why are you interested in starting your own ABA Therapy practice? (check all that apply)*

I'm looking for the next step in my career path

I'm tired of seeing Venture Capitalists and Private Equity firms take over our field

I'm looking to create a solid financial future for myself and/or my family

I believe in Clinically Owned and Clinically Operated ABA Therapy practices

I'm looking to help flip the script from corporate control to clinician-driven excellence

Other

Please share...