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Auesomely You™

Custom AAC Lanyard Intake Form

First name*

Last name*

Email*

Phone*

Child’s First Name*

Child’s Last Name*

Communication style (check all that apply)*

Non-verbal

Limited speech

Uses PECS

Uses AAC device

Other

Vocabulary Selection

Choose up to 40 words/phrases your child uses or needs help expressing. You can type them below or upload a list/photo. (You may group by categories if you wish — e.g., emotions, foods, activities.)*

List Your 40 Words Below:

(Each word/phrase can be 1–3 words, like “I want” or “Wash hands”)

Visual Preferences

Does your child recognize real photos or prefer illustrated icons?*

Real photos

Clipart-style icons

Doesn’t matter

Would you like to upload any custom icons (e.g., your child's face, specific toy, or home routines)?*

Yes – I’ll upload them

Personalization Options

Preferred skin tone for character icons (optional):*

Light

Medium brown

Dark

No preference

Add child’s name to the lanyard?*

Yes

Include emergency contact info on the back?*

If yes, please provide:

Name: _______________

Phone: _______________

Delivery Info

Address*

Custom Landyard*

Starter Pack 1 AAC Lanyard with 40 Standard Core Vocabulary Icons (not custom)$25

Custom Child Pack 1 Personalized AAC Lanyard$40

Sibling + Caregiver Bundle$105

School Pack 10 Custom Lanyards$275

Add-On Lanyard$18

Let's Connect

First Name*

Last Name*

Email*

Phone

Type your message here...

Email: crystaljordantheadvocate@gmail.com

Phone: 404-380-0059

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Auesomely You™

Custom AAC Lanyard Intake Form

Visual Preferences

Personalization Options

Delivery Info

Let's Connect

Get My Weekly Aueesome Tips

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