Huntington University A.B.L.E Program Application

Transcription

1 Application Instructions: It is recommended that the student, his/her Teacher of Record (if still enrolled in a secondary program) and parents work collaboratively to complete this application. Please complete the ABLE Application and attach the following items: o High school transcript o Most current IEP o Most recent Educational Evaluation report o Any relevant assessments, work history, or other pertinent information Interested applicants may submit applications to: Erica Marshall, ABLE Coordinator EMarshall@huntington.edu 2303 College Ave. Huntington IN Phone: Fax: Please keep a copy of the application packet for your personal records. ABLE Applicants Must: Have a documented cognitive disability Be working towards/have a Certificate of Completion Have the capacity to be independent and unsupervised while on campus Meet eligibility requirements for Indiana Vocational Rehabilitation Services (VRS) Have the capacity to comply with campus and ABLE program policies Be willing to explore transportation options and be trained to travel independently Have maintained acceptable attendance (currently or in the past) Have maintained the schools Discipline Policy (currently or in the past) Be willing and able to attend chapel on campus

2 Applicant Selection Process Applications should be submitted by March 1 st of the year prior to admission (exceptions can be made if Coordinator is contacted) The ABLE Admissions Committee reviews the ABLE Application and attached documents The ABLE Program conducts an admissions interview with the student The student will be informed of admission by mail/ within 30 days of the last round of interviews If you have any questions, please contact Erica Marshall. ABLE Application

3 The following questions are to be answered by the student, parent(s)/guardian(s) and student s Teacher of Record, as appropriate. It may also be helpful to receive input from other transition team members. Student Name: Birthdate: SSN: School District: Applicant s Address: Applicant s Phone Number: Parent s Phone Number: Applicant s Living Arrangement [i.e., family home, group home, supported living]: Has the applicant completed a secondary education program? (please answer the following questions either for the student s previous or current program): Where was/is the program located (district/school)? What was/is the applicant s exit date? Teacher of Record Name: Teacher of Record Phone Number: Teacher of Record 1) What community-based outcomes are projected in your (the student s) current or exiting IEP? (Please address the following areas: employment, community living, postsecondary education, community participation, recreation/leisure, etc.)

4 2) What community based work experiences (paid or unpaid) has the applicant had to date? Employer Location Hours Pay Dates Level of Support (1-5, 1 no support needed 5 must have a job coach) 3) What community based learning experiences has the student had to date? Please include the level of supported needed for successful learning outcomes. 4) How is the applicant transported to and from non-school activities?

5 5) Is the applicant able to contact public transportation services in order to schedule needed transportation? o Yes o No 6) What level of support does the applicant generally need for activities of daily living? No Support Some Support High Level of Support ) Is the applicant able to communicate wants and needs clearly? No Support Some Support High Level of Support ) Are there any of the following considerations that the ABLE Interview Committee should be aware of (for safety and support purposes)? Please check all that apply. X Consideration Notes: Medical (Please include medications taken during the school day.) Assistive Technology Behavioral Concerns Means of Communication Safety Needs

6 9) Please provide information regarding social service agencies that the applicant may already be linked with for support? X Social Service Agency Notes: Bureau of Developmental Disabilities (BDDS) Vocational Rehabilitation (VR) Social Security (Please include a copy of the award letter.) Waiver: CIH or Family Support Services, Other Date Selected: On Waiting List Since: If receiving this service what adult agency service provider has been selected? Referral Date: Receiving Services Since: VR Counselor: If receiving this service what adult agency service provider has been selected? SSI Date: SSDI Date: Health Insurance Yes Private Health Insurance or Medicaid: MAD or HIP No Other: Please Provide more information: 10) Why would the applicant benefit from the ABLE program?

7 11) Applicant s References, these should be references who are not related to the Applicant. Name: Title/Organization: Address: Phone 12) Please provide the ABLE Interview Committee any information that you feel might be relevant to the applicant and selection for the ABLE program. Applicants Signature: Parent/Guardian Signature: Date: