Rhode Island College Certificate of Undergraduate Study in ...REVIEW ONLY Rhode Island College...

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Rhode Island College Certificate of Undergraduate Study in

College and Career Attainment Student Application Guidance

Each application must include:

Requirement for Application Method of Submission Certificate of Undergraduate Study APPLICATION

FORM Completed online

High school transcript reflecting completion of four years of high school for dual enrollees

or High school diploma or an alternative diploma such as a certificate of completion

Document scanned and uploaded to online Application Form (preferred) Or mailed to address noted in application

Documentation of Intellectual Disability: The most recent complete evaluation report documenting presence of an intellectual disability (Examples of documentation: an educational evaluation or a psychological evaluation report, or a note from a physician).

Document Scanned and uploaded to Application Form (preferred) Or mailed to address noted in application

1 Recommendation from a teacher or other individual who is familiar with the applicant’s strengths in academic, extracurricular, and community experiences

Teacher mails paper recommendation to address noted on recommendation.

1 Recommendation from a community member who is familiar with the applicant’s strengths in experiences outside of school (community, work, recreation)

Community member mails paper recommendation to address noted on recommendation.

Personal Statement Questionnaire describing why the applicant is interested in the program, their strengths, and the areas in which they need support

Completed online (preferred) or Printed, scanned and uploaded to online application Interview Scheduled after committee review of application materials

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Certificate of Undergraduate Study in College and Career Attainment Application Form 2016 pg. 2

Certificate of Undergraduate Study (CUS) in College and Career Attainment (CCA)

Student Application Form The information in this document is to be used to prepare for online submission. It is acceptable for the applicant to receive support, if needed, in completing this application online. All sections must be completed in order to consider the applicant for admission to the CUS in CCA. All information is confidential and will not be shared with any outside agencies unless written release is provided by those filling out the application. This application is submitted online. If assistance is needed in scanning or submitting application materials, please contact:

Claire Rosenbaum Email: [email protected] Direct Line: (401) 456-4732 Main Line: (401) 456-8072 TTY via RI Relay: 711 or (800) 745-5555 Spanish via RI Relay: 711 or (866) 355-9241

STUDENT INFORMATION Last Name First Name MI Birth Date

Address Male Female

City State Zip Code Home Phone

Email address Cell Phone

Applicant’s Ethnicity Choose one (optional) ___ Hispanic or Latino ___Not Hispanic or Latino Applicant’s Race Choose one (optional) ___ Asian ___ American Indian or Alaska Native ___ Black or African American ___ Native Hawaiian or Other Pacific Islander ___ White

Additional Information Check all that apply if known ___ Applicant is enrolled with Office of Rehabilitation Services (ORS) ___ Applicant is enrolled with BHDDH (Division of Developmental Disabilities)__

mailto:[email protected]

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FAMILY INFORMATION Student lives with: Both parents

Mother

Father

Guardian(s)

Other:

Mother / Guardian: Last Name First Name MI Home Phone

Address Best Phone Contact Number

City State Zip Code

Email address

Father / Guardian: Last Name First Name MI Home Phone

Address Best Phone Contact Number

City State Zip Code

Email address

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STUDENT’S EDUCATION HISTORY Schools Attended Last Five Years (Name, City, State)

School Years Attended

Reason for leaving (if other than graduation)

Did / will you receive a high school diploma or equivalent? Yes No

From (school) Date

HIGH SCHOOL TRANSCRIPT/HIGH SCHOOL DIPLOMA The student applicant will need to obtain a copy of their high school transcript reflecting completion of four years of high school for dual enrollees Or a copy of their High school diploma or an alternative diploma such as a certificate of completion.

How to submit this documentation: Preferred: This document should be obtained in a digital format or scanned in to be uploaded to the online application.

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Documentation of Student Applicant’s Intellectual Disability

To be eligible for the Certificate of Undergraduate Study in College and Career Attainment, there must be documentation that the student has an Intellectual Disability.

An Intellectual Disability is defined as a disability that is characterized by

significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills.

(American Association on Intellectual & Developmental Disabilities, 2010). A detailed definition is available at www.AAIDD.org.

Student applicant’s Intellectual Disability must be supported by one of the following. Please indicate the source of documentation you will upload/mail as part of this application.

Educational Report ____ Psychological Report

Physician’s Report/letter __ other record (please specify) ______________________ Upload a copy of the documentation indicated above (preferred)

or Mail a copy of documentation of applicant’s Intellectual Disability to:

Certificate of Undergraduate Study in College and Career Attainment Sherlock Center on Disabilities Rhode Island College 600 Mt. Pleasant Avenue Providence, RI 02908

http://www.aaidd.org/

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Teacher Recommendation The applicant will provide the Student Recommendation-Teacher paperwork to a teacher who is familiar with the applicant’s strengths in academic, extracurricular, and community experiences. The teacher will mail the form to the Rhode Island College address on the recommendation.

The online application will request the following information:

Name of Teacher completing the recommendation

School

Community Member Recommendation The applicant will provide the Student Recommendation-Community Focus paperwork to a community member who is familiar with the applicant’s strengths in experiences outside of school (community, work, recreation). The community member will mail the form to the Rhode Island College address on the recommendation.

The online application will request the following information:

Name of Community Member completing the recommendation


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College and Career Attainment Student Recommendation -Teacher

TO THE APPLICANT After completing all the applicant information, give this form to a teacher who knows you and your work. The teacher will send the recommendation form to the address below at Rhode Island College.

Female Applicant’s Name Birth date Male

First Name Middle Name Last Name

Address Number & Street City/Town State/Province Zip

IMPORTANT PRIVACY NOTICE: Under the terms of the Family Educational Rights and Privacy Act (FERPA), after you matriculate you will have access to this form and all other recommendations and supporting documents submitted by you andon your behalf unless you waive your right to access below:

Yes, I do waive my right to access, and I understand I will never see this form or any other recommendations submitted byme or on my behalf

No, I do not waive my right to access, and I may someday choose to see this form or any other recommendations orsupporting documents submitted by me or on my behalf to the institution at which I am enrolling.

Required Signature Date

TO THE TEACHER The above named individual is applying for admission to the Certificate of Undergraduate Study in College and Career Attainment at Rhode Island College. This course of study is designed to support students with intellectual disabilities who desire a career-oriented, postsecondary experience on a college campus and require a strong system of supports. Eligible students are highly motivated young adults who have received extensive educational services in either public or private schools and would likely have considerable difficulty succeeding in a traditional college degree program.

Students should have a strong desire to become more independent and must possess emotional stability and maturity to participate successfully in this program.

With the above information in mind, please answer the following questions to the best of your ability. Please return this form to: Certificate of Undergraduate Study in College and Career Attainment

Sherlock Center on Disabilities Rhode Island College 600 Mt. Pleasant Avenue Providence, RI 02908

Teacher’s Name

Signature Date

Name of Secondary School

School Address Number

& Street City/Town

State/Province Zip Code

Teacher’s Contact Phone Number Teacher’s E-mail

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Student Recommendation- Teacher (page 2)

Applicant’s Name

Please state the length of time you have known this applicant: Years Months

Nature of acquaintance

Please describe why you feel the applicant would benefit from a career-oriented, postsecondary education experience.

Please evaluate the following items on a four-point scale as indicated below. Should you not be familiar with the applicant’s skills in a particular area, please indicate this as Unknown.

1 2 3 4

Completely Independent

Needs minimal

assistance

Needs moderate assistance

Needs Complete Assistance

Unknown

Social/Communication Skills Use of judgment skills in making decisions Communicating in an appropriate manner (oral and/or augmentative communication)

Communicates in writing. Communicates effectively email. Engaging in appropriate social interaction (academic and social situations)

Academic/Study Skills Manages time and schedule to complete assignments Motivation to learn and persist on new tasks

Non-Academic Skills Adapts to changes in schedule, environments, & people. Willing to try new things Able to navigate within a classroom Able to navigate around larger spaces such as a building or a campus.

What accommodations support this student’s academic and non-academic learning?

Please describe any additional applicant strength, challenge, and opportunities for growth to be considered.

Rhode Island College reaffirms its policy of equal opportunity regardless of race, color, creed, religion, national origin, sex, sexual orientation, age, marital status, disability, or status as a disabled veteran or Vietnam era veteran.

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College and Career Attainment Student Recommendation- Community Focus

TO THE APPLICANT

After completing all the applicant information, give this form to a community member who knows you. The community member will send the recommendation form to the address below at Rhode Island College.

Applicant’s Name Birth date

First Name Middle Name Last Name

Female Male

Address Number & Street City/Town State/Province Zip

IMPORTANT PRIVACY NOTICE: Under the terms of the Family Educational Rights and Privacy Act (FERPA), after you matriculate you will have access to this form and all other recommendations and supporting documents submitted by you andon your behalf unless you waive your right to access below:

Yes, I do waive my right to access, and I understand I will never see this form or any other recommendations submitted byme or on my behalf

No, I do not waive my right to access, and I may someday choose to see this form or any other recommendations orsupporting documents submitted by me or on my behalf to the institution at which I am enrolling.

The above named individual is applying for admission to the Certificate of Undergraduate Study in College and Career Attainment at Rhode Island College. This course of study is designed to support students with intellectual disabilities who desire a career-oriented, postsecondary experience on a college campus and require a strong system of supports. Eligible students are highly motivated young adults who have received extensive educational services in either public or private schools and would likely have considerable difficulty succeeding in a traditional college degree program.

Students should have a strong desire to become more independent and must possess emotional stability and maturity to participate successfully in this program.

With the above information in mind, please answer the following questions to the best of your ability. Please return this form to:

Certificate of Undergraduate Study in College and Career Attainment Sherlock Center on Disabilities Rhode Island College 600 Mt. Pleasant Avenue Providence, RI 02908

Required Signature Date

Community Member’s Name

Signature Date

Contact Phone Number E-mail

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Student Recommendation- Community Focus (page 2)

Applicant’s Name

Please state the length of time you have known this applicant: Years Months

Nature of acquaintance

Please describe why you feel the applicant would benefit from a college experience. (Please use back of form if more space is required.)

Briefly describe your overall impression of this applicant: (Please use back of form if more space is required.)

Please evaluate the following items on a four-point scale as indicated below. Should you not be familiar with the applicant’s skills in a particular area, please indicate this as No Ability to Judge.

1 2 3 4 No Below

average Average Good Excellent Ability to Judge

Use of judgment in making decisions

Respect for others

Initiative

Creativity

Self confidence

Self-discipline

Character/Integrity

Perseverance

Potential for growth

Motivation to learn

Adapts well to changes in schedule, environments, & people.

Willing to try new things

Rhode Island College reaffirms its policy of equal opportunity regardless of race, color, creed, religion, national origin, sex, sexual orientation, age, marital status, disability, or status as a disabled veteran or Vietnam era veteran.

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Personal Statement Questionnaire (To be filled out by applicant online with guidance from parent/family/guardian/support person.)

SUPPORT NEEDS: Put a check in the box that best describes your support needs.

1 I can do this on my own

2 I need a little help with this

3 I need a good bit of help with this

4 I need a lot of help with this or someone else needs to do this for me

INDEPENDENT LIVING SKILLS Finding your way around a building Ordering & purchasing from a cafeteria/restaurant

Managing personal belongings

Getting along with others

Asking other people for help when I need it

Coping with stress

Adjusting to new situations

1 2 3 4

ACADEMIC SKILLS

I can do this on

my own

I need a little help with this

I need a good bit of help with this

I need a lot of help with this or someone else

needs to do this for me Handling money: counting change/bills

Computer Skills: Word processing, using the internet

Wanting to learn new things and trying even when things are hard

Following spoken directions Following written direction Keeping a daily schedule with due dates and assignments

Do you use any device, technology, or equipment to help you do things more easily? If yes, what?

Additional Remarks: Please list/discuss any physical, intellectual, social, or emotional conditions that may need to be considered when planning your college experience.

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PERSONAL STATEMENT This section is filled out by applicant and may be completed with the assistance of another person. This is an excellent opportunity to show off your writing skills, critical thinking skills and your creativity

(1) Why do you wish to be considered for the Certificate of Undergraduate Study in College and Career Attainment at Rhode Island College?

(2) What strengths do you feel would make you a good match for the Certificate of Undergraduate Study in College and Career Attainment?

(3) What would you like to learn about in a college class?

(4) What kind of jobs or careers are you interested in after you leave school?

(5) Discuss two of your goals for the future when you complete your study at Rhode Island College?

(6) Please use this section to provide us with any additional information about yourself that you wish to share. (optional)

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Certificate of Undergraduate Study in College and Career Attainment at RIC Student

Application Signature Sheet

Certificate of Undergraduate Study in College and Career Attainment Eligibility Criteria, the applicant must:

___ Be at least age 18 at the start of the first full semester of classes

___ Have a documented Intellectual Disability

___ Have a strong desire to become more independent, and demonstrate sufficient emotional stability and maturity to participate successfully in college coursework, internships, and the campus environment

___ Demonstrate the ability to act consistent with the Rhode Island College Student Code of Conduct. Note: RIC does not have the personnel to supervise students with difficult and challenging

behaviors, to dispense medications, or provide personal health aids and services.

___ Demonstrate the desire to attend Rhode Island College (RIC) and adhere to the RIC policies regarding attendance and participation.

___ Have the potential to successfully achieve his/her goals within the context of his/her Certificate of Undergraduate Study in College and Career Attainment Plan of Study.

NOTE: • A limited number of applicants will be admitted each year. Not all applicants who complete the

application and meet the criteria for admission will be accepted into the Certificate of Undergraduate Study in College and Career Attainment. The decision to offer or deny admission will be made by the Admission Committee in their best judgment and in the best interest of the applicant.

• Students completing this program will receive a certificate of completion, will have access to a RIC

transcript documenting their college courses, and a personal employment portfolio.

SIGNATURE

If enrolled in the Certificate of Undergraduate Study in College and Career Attainment, it is my understanding that:

___ I am responsible for arranging transportation to and from RI College each semester. ___ I am responsible for administering or arranging for administration of any medications or medical

treatments needed while on campus. ___ I am responsible for arranging any personal care assistance needed to participate in this program. ___ I am responsible for payment of RIC tuition/fees, books, and other course materials ___ I have reviewed the Certificate of Undergraduate Study in College and Career Attainment Eligibility

Criteria.

Student Signature Date

Rhode Island College Certificate of Undergraduate Study in ...REVIEW ONLY Rhode Island College...

Documents

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