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Think College WyomingStudent Application Packet

2015

Think College Wyoming

Wyoming Institute for Disabilities

Dept. 4298, 1000 E University Ave.

Laramie, WY 82071

Phone: (307) 766-2766

Toll Free: 1-888-989-9463 TTY:

1-800-908-701

Fax: (307) 766-2763

E-mail: TCW@uwyo.edu

All applications will be reviewed by the

Think College Wyoming Selection Committee

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Application for selection procedure In order to ensure Think College Wyoming is the best match for our applicants, we require the application

packet to be completed by each student. This program of study is for unique learners who are highly

motivated young adults whose “disability” is characterized by significant limitations both in intellectual

functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills.

Applicants will have received extensive special education services in their secondary schools and would

have considerable difficulty succeeding in a traditional college degree program.

Applicants must have a strong desire to become an independent adult and demonstrate sufficient

emotional stability and maturity to participate successfully in the program.

This is not an accredited college degree program, and exiting students will receive a certificate from Think

College Wyoming

Note: Not all applicants who complete the application and meet the “criteria for admission” will be

interviewed or selected. For Fall 2015 admission, Think College Wyoming will select two students at two

new community college site. Two alternate students will also be selected.

Questions?

You may E-mail TWC@uwyo.edu

Please send all admissions materials to:

Think College Wyoming

Wyoming Institute for Disabilities

Dept. 4298, 1000 E. University Ave.

Laramie, WY 82071

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Application Process Checklist

Step 1

Complete and submit the Student Application Packet

Submit High School Transcripts

Submit Evaluation Documenting Disability

Submit Letters of Recommendations

Step 2

When requested schedule and attend a personal interview accompanied by a

parent/family/guardian/ support person.

Application Selection Process

The Think College Wyoming Selection Committee will review applications and select students for interview.

Please do not call about the status of your application, as we will not be able to provide this information for

you over the phone. You will receive an E-mail, phone call, or letter letting you know of your interview status.

After interviews, Think College Wyoming will select two students at two new community college site. Two

alternate students will also be selected.

Note: A limited number of applicants will be admitted each year.

The decision to offer or deny admission to Think College Wyoming will be made by the Selection Committee

in their best judgment and in the best interest of the applicant. Admission will be based on the following

criteria:

Applicants must be between the age 21-26 at the start of the program

The applicant must have a significant intellectual disability that interferes with his/her academic

performance (AIDD definition of intellectual disability).

The applicant must have sufficient emotional and independent stability to participate in all aspects of

the TCW coursework and campus environment. Note: TCW does not have the personnel to supervise

students with difficult and challenging behaviors or dispense medications.

The applicant must demonstrate the desire to cooperate with TCW and adhere to the college attendance

and participation for classes.

The applicant must have the potential to successfully achieve his/her goals with the context of the TCW

mission.

The applicant has completed high school with a modified standard, special diploma, or certificate of

completion.

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Application for Selection After the TCW Selection Committee reviews the application packet, a small number of students will be

contacted to schedule an interview. The interview must include the prospective student and his or her

parent/family/guardian/support person.

The applicant is requested to complete the TCW Student Application (Item 1 below) as independently as

possible, and must complete student questionnaire him or herself. The application can be typed or printed

neatly.

Application Checklist

1) ____ TCW Student Application Packet which includes:

___Applicant Information

___Family Information/Emergency Contact

___Education History

___Employment History

___Transportation/Housing

___Release/Exchange of Information Form

___Personal Support Inventory to be completed by parent/guardian/support person

___Student Questionnaire to be completed by the applicant

___Recent photo (attach with packet)

2) ____ Official High School Transcript, last IEP, and if applicable, a record of any

postsecondary experiences

3) _____ Evaluation documenting disability, preferably conducted within the past three years as a

component of the applicants’ eligibility.

4) _____Two Letters of Recommendation from persons who have known the applicant for one year

or longer, from two of the following (1) education; (2) vocational/ employment; (3) community

involvement; and (4) personal. Letters must be submitted using the Recommendation Form and

returned with the application packet as directed on the form. Letters of Recommendation must

be included in a sealed envelope with signature across the seal.

NOTE: Applications will not be considered unless ALL requested information is present at the time of

review.

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Application Information Please complete all sections of this application. (Pages 5-14) It is acceptable for the applicant to receive

support, if needed in completing this section of the application. You may attach additional information and

pages for writing space if needed. We request all sections be completed in order to assist us in determining

this applicant’s acceptance into the program. All information is confidential and will not be shared with any

outside agencies unless written agreement is provided by those filling out the application.

STUDENT INFORMATION Student Name Home Phone

Address

City State Zip Code Birth Date

E-mail address Cell Phone

Student receives support from: (please check those that apply)

_____ Supplemental Security Income

_____ Division of Developmental Disabilities (DDD Self Directed Supports)

_____ Medical Assistance

_____ Social Security Disability Insurance

_____ Division of Vocational Rehabilitation

_____ Other _________________________________________________

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FAMILY INFORMATION

Student lives with:

_____Both parents _____ Mother _____ Father _____ Guardian(s) _____Other

Mother/Guardian Name Home Phone

Address

City State Zip Code Work Phone

E-mail Address Cell Phone

Father/Guardian Name Home Phone

Address

City State Zip Code Work Phone

E-mail Address Cell Phone

Who is the student’s legal guardian (e.g. mother, father, grandparent, self)?___________________________

EMERGENCY CONTACT INFORMATION In case of an emergency, please contact:

_______________________________________________ at ___________________________

(name) (phone)

_______________________________________________ at ___________________________

(name) (phone)

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EDUCATION HISTORY Schools Attended (Name, City, State) Years attended Reason for Leaving

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

From (school) ________________________________ Date _________________

Please briefly describe your academic strengths and weaknesses.

In what ways do you learn best? (e.g. small groups, extra time)

In the following areas, what skills you would like to learn?

Academics:

Vocational and Career:

Independent Living:

Social / Recreation:

Have you participated in general education classes through your K-12 education? Yes No

If yes, please describe:

Were any accommodations used? Yes No

If yes, what kind?

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EMPLOYMENT HISTORY Note: prior work experience is not a requirement for admission into this program

Business/Employer/

Volunteer Site

Paid or

Unpaid

Job

Responsibilities

Reason for

Leaving

Amount of

time at job

If you are currently participating in a paid or unpaid work / volunteer experience, please describe.

Please describe the careers you are interested in exploring. You may describe environments and areas of

interest and not merely career titles.

TRANSPORTATION / HOUSING If accepted I would . . .

Commute from my home

Live with support near campus

Live without support near campus

Other (Please Describe)

If necessary what are your plans for transportation to be used to participate in this college experience?

If necessary, will this transportation plan allow for recreational, social, and leisure opportunities to occur

after 3 p.m. and on weekends?

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Think College WyomingRelease and Exchange of Information Form

Think College Wyoming treats and regards all written documentation obtained to verify a disability and plan

for appropriate services as well as all documented services and contracts as confidential. However, it may be

necessary for our staff to exchange some information about you with the college faculty and staff in order to

provide you with educational opportunities and experiences on and off campus. This exchange will occur

only with your written permission, as given in this document below, and with the understanding that only

information necessary for the purposes of accommodation and academic progress will be communicated.

Name _________________________________________

I give permission to exchange information about me to the following offices/individuals checked below:

______ School District(s) __________________________________________________________

______ DVR Office

______ DDD Office

______ Admissions Office

______ Counseling Office

______Course Instructors

______ Financial Aid Office

______Parents/Guardians

______Registrar’s Office

______ Tutor

______ Other

(Specify)

______ I agree, as part of the application process, to waive my right to access the student recommendation

form.

Additionally, I hereby give permission for Think College Wyoming the right to use my photograph and/or

quotes and videotapes of me for public relations and/or training purposes.

Student Signature ____________________________________Date ___________________

Parent/Guardian _____________________________________Date ___________________

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PERSONAL SUPPORT INVENTORY To be filled out by: Parent/family/guardian/support person: Use an “X” to indicate selection.

Name of person completing inventory:

Relationship:

Independent Living

Skills

1

Requires

complete

assistance

2

Needs

moderate

assistance

3

Needs

some assistance

4

Needs

minimal

assistance

5

Completely

independent

Negotiating/

finding way

around campus

environment

Ordering and

purchasing from a

restaurant/cafeteria

/store

Handling personal

affairs: laundry,

light cooking,

cleaning,

managing personal

belongings

Ability to relate to

others

Asks for help,

clarification, or

questions

Use of judgment

skills in an

emergency

Copes with stress

Adjusts to new

situations

Social Skills and

Communication

1

Requires

complete

assistance

2

Needs

moderate

assistance

3

Needs some

assistance

4

Needs

minimal

assistance

5

Completely

independent

Communicating

needs in appropriate manner

11

Engaging in

appropriate social

interaction

Using cell phone,

E-mail, texting

Academic Skills

1

Requires

complete

assistance

2

Needs

moderate

assistance

3

Needs

some

assistance

4

Needs

minimal

assistance

5

Completely

independent

Handling money; counting

change/bills, understanding

values, using checkbook,

staying within budget

Approximate grade levels:

____________ Reading

____________ Writing ____________ Mathematics

Computer Skills:

Word processing

Computer skills: Internet

Motivation to learn and persist

on new tasks

Knows and can verbalize

and/or write personal

information: name, address,

phone, etc.

Ability to follow verbal

directions

Ability to follow written

directions

Ability to keep a daily schedule

with due dates and assignments

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Has the applicant utilized any assistive technology? If yes, what?

Additional remarks: Please list/discuss any physical, intellectual, social or emotional conditions that may

need to be considered when planning a postsecondary experience.

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Student Questionnaire

(To be filled out by applicant and may include additional pages. This is an excellent opportunity to show off

your writing skills, your critical thinking skills, and your creativity.) Please include a photo with this

questionnaire.

1. Why do you wish to be considered for participation with Think College Wyoming?

2. Which community college are you hoping to attend and why?

3. What would you like to study in college?

4. If you need help in college, would you ask for help? Who would you ask?

5. What do you want to learn that you haven’t learned in high school?

6. What kind of jobs are you interested in after you leave school?

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7. What do you do in your free time?

8. What is your favorite hobby or sport?

9. What is your favorite musical group or favorite singer?

10. Do you spend time with friends outside of school? YES NO

11. If yes, what do you like to do with your friends?

12. Discuss two of your goals for the future upon completion of this program?

13. Please use this space to provide us with any additional information about yourself that you wish to

share.