Career Academy Applications

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Student Information

Student Name*
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Parent Information

Student Name*
Parent Name*
Parent Address

Student Information

Student's Legal Rights*
Education Information*
Transportation: How do you plan to get to the Project SEARCH work sites?*

Service Agencies

Are you a client of Vocational Rehabilitation?*

Independent Living

Behavioral Summary

TRANSITION SERVICE NEEDS - check ALL areas you need help with

Daily Living Skills
Travel Training
Community Experience

Work Experience Information

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IMPORTANT INFORMATION - In this section mark all the things you can do on your own

Independent Living*
Social / Recreational Leisure*

Student Response Questions

Please answer the following questions to the best of your ability. Answers should be brief. Information you provide may be used during the interview.

List Three References (No Family Members)

Note: During the interview, be prepared to discuss job skills you would like to learn, things you need to learn to be more independent, work experience and career goals. Please bring your social security card and government-issued photo identification. Acceptance into the program cannot be approved without these documents.

List Three References (No Family Members)

Please provide 1 work, 1 school and 1 personal reference
Work Reference Name*
School Reference Name*
Personal Reference Name*

This application was completed by (if other than applicant):

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