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FloridaAtlanticUniversityAcademyforCommunityInclusionProgramApplicationPacketFall2017ApplicantName:Fall,20172FloridaAtlanticUniversityAcademyforCommunityInclusionProgramOverviewTheFAUAcademyforCommunityInclusionisacomprehensivetransitionprogramforindividualswithintellectualanddevelopmentaldisabilities.
Studentswillhavetheopportunitytodeveloptheiracademic,vocationalandsocialskillsatthepost-secondarylevel.
Thecoursesandcertificatesofferedarebasedonthestrengthsandneedsoftheindividualparticipant.
TheprogramishousedontheJupiterCampusofFloridaAtlanticUniversity.
EligibilityCriteriaApplicantsmust…HaveadocumentedintellectualanddevelopmentaldisabilityBeatleast18yearsoldHavegraduatedorcompletedhighschool(canprovideatranscriptindicatingcompletion)BecapableofmeetingpersonalneedswithoutassistanceBeabletoself-administeranynecessarymedicationHavenobehaviordifficultiesHavethecapabilitytoparticipatein50to90minuteclassesNavigatethecampusindependentlyHavethedesiretoparticipateinacollegeprogram.
ApplicationProcess1.
ApplytotheFAUAcademyforCommunityInclusionbycompletingthispacket.
2.
WhenyouhavecompletedtheAcademyforCommunityInclusionapplicationdeliveryittoFAUJupiterCollegeofEducation:ECBuildingroom202ormailitusingtheaddressonpage3ofthisapplication.
Incompleteapplicationwillnotbeincludedintheapplicantreviewprocess.
3.
Qualifiedapplicantsareinvitedforastudentandfamilyinterview.
4.
ApplicantsarenotifiedbymailofacceptancetotheprogramandwillthenneedtosubmitanapplicationtoFAU.
ApplicantName:Fall,20173FloridaAtlanticUniversityAcademyforCommunityInclusionApplicationChecklist1.
CompletedAcademyforCommunityInclusionApplicantPacket2.
CopyofmostrecentIndividualEducationPlan(IEP)3.
Copyofmostrecentpsychologicaloracademicevaluation4.
Highschooltranscriptshowingproofofgraduation5.
Recentphoto/headshotofapplicant6.
Three(3)lettersofrecommendation:two(2)shouldbeprofessionalandone(1)personal7.
Personalvideostatement(digitalcopyoftheapplicant'sresponsestoquestionsonpage22ofthisapplication8.
Signedapplicantcontract9.
SignedParent/Guardian/Caretakermemorandumofunderstanding10.
Signedreleaseofinformationform11.
Signedphoto/mediareleaseform12.
SignedFERPAwaiverSendordelivertheCOMPLETEDApplicationPacketto:FAUAcademyforCommunityInclusionCollegeofEducationEducation/ClassroomBuilding(EC202)5353ParksideDriveJupiter,FL33458***DeadlineforFall,2017ApplicationsisJune15th,2017PleasesendquestionstoACI@fau.
eduApplicantName:Fall,20174DearFAUAcademyforCommunityInclusionApplicant:Weareveryexcitedtobeabletoofferthisprogramtoyouasanoptionforapathwaytoindependence.
TheAcademywillgiveyouachancetogotocollegewithsomecollegestudentswhoareyourage,andsomewhomightevenbeolder.
FAU'sMacArthurCampusisverydiverse.
That'sonereasonthatitistheperfectplacetobeginyourcollegecareer.
AsanFAUAcademyforCommunityStudentyouareanFAUstudentfirst.
YouwillhaveanOWLCard,takepartincampusevents,andgotostudentactivities,footballgames,andconcerts.
EverythingthatanyonewoulddoasastudentatFAU.
Itisnotallfunandgames,however.
TheAcademyforCommunityInclusionisacombinationofcollegecourses,workexperiences,collegelife,aswellascollegecampusactivities.
TheprogramofferschallengingcoursesthatleadtocertificationsinSupportedEmployment,SupportedCommunityAccess,andSupportedCommunityLiving.
Thegoalofeachcertificateprogramistobuildself-determinationskillsintoeachcourse.
Bythat,wemeanthatyouwilllearnaboutyourownstrengthsandaboutthethingsyouhaveaccomplished.
Youwillbetterunderstandthewayyouhandlechallengesandthestrategiesthatworkbestforyou.
ThecertificateinSupportedEmploymentwillleadtoworkexperiences,beginningoncampusandthenmovingoutintothenearbycommunityandfinallytoacompetitivejob.
ThecertificateinSupportedCommunityAccesswillprovideyouwiththeskillstomoveaboutthecommunityasindependentlyaspossible.
Youwilllearnhowtotravelusingvariousmodesoftransportation,howtomanageschedules,andhowtobesafewhileyouaretraveling.
ThecertificateinSupportedCommunityLivingwillimproveyourindependentlivingskillsandhelptransitiontoamoreindependentlifestyle.
Youcanworkononeorallthreeofthecertificates.
Thisisanimportantstepforyou.
Onethatshouldbetakenveryseriously.
Asyoufillouttheapplication,thinkabouthowimportantitistotaketheprocessveryseriouslyandhonestly.
Readallthedirectionsandcompletethepacketbeforeyouturnitin.
Wewillinterviewfinalistapplicantsaspartoftheprocess.
Ihopewewillmeetyoufacetofaceverysoon.
Sincerely,Dr.
MaryLouiseDuffyProfessorandACIProjectCoordinatorApplicantName:Fall,20175ApplicantInformationLastNameFirstNameMiddleNameDateofBirthGenderStreetAddressCityStateZipCodeHomePhoneCellPhoneEmailAddressHowdidyouhearaboutourprogramIcurrentlylive.
.
.
.
.
.
Withmyfamily/parentsGroupHomeIndependentlyOtherIgetaroundtown…(Checkallthatapplytoyou)WithmyfamilyUsingpublictransportationBydrivingmyselfOtherBywalkingApplicantName:Fall,20176EducationHistorySchoolNameCity,StateYearsAttendedWhatwereyourfavoritesubjectsinhighschoolWhatsubjectsinhighschoolwerethemostdifficultforyouHowdoyoulearnbest(smallgroups,handson,etc.
)ApplicantName:Fall,20177EmploymentHistoryEmployerJobResponsibilitiesDatesVolunteerSiteResponsibilitiesDatesWhatworkexperiencesdoyouhaveaninterestinorenjoyWhattypeofjobdoyouhopetohaveinthefutureApplicantName:Fall,20178Guardian#1FamilyInformationLastNameFirstNameMIRelationshiptoStudentHomePhoneCellPhoneEmployerBusinessPhoneStreetAddressCityStateZipEmailAddressGuardian#2LastNameFirstNameMIRelationshiptoStudentHomePhoneCellPhoneEmployerBusinessPhoneStreetAddressCityStateZipEmailAddressSiblingNameAgePhoneApplicantName:Fall,20179MEDICATIONINFORMATIONMedicalConditions***GlassesYes()No()ContactsYes()No()HearingaidsYes()No()DoyouhaveanyphysicaldisabilitiesorlimitationsthatweneedtobeawareofforthisprogramPleasedescribe.
Doyouhaveanymedicalconcernsthatweshouldbeawareofforthisprogram(Asthma,ADHD,Seizures)DoyouhaveanyallergiesPleaselistallergensandseverity.
Doyourequireattendantcareforpersonalneeds***Ifadmitted,theFAUAcademyforCommunityInclusionwillrequiredetailedinformationregardingmedicationinsuranceandemergencycontacts.
Doyoutakemedication(s)Yes()No()DoyouneedassistancewithtakingyourmedicationYes()No()DoyourequirephysicalsupportsMarkallthatapplytoyou.
UsesamanualwheelchairYes()UsesanelectricwheelchairYes()UsesawalkerYes()UsesacaneYes()Useshandrailsinthebathroom/showerYes()HowdoyouhandleyourownphysicallimitationsApplicantName:Fall,201710FloridaAtlanticUniversityAcademyforCommunityInclusionIndividualEducationPlanRemovethisblankpageandinsertyourMOSTRECENTIEPinitsplace.
ApplicantName:Fall,201711FloridaAtlanticUniversityAcademyforCommunityInclusionPsychological/AcademicEvaluationRemovethisblankpageandinsertyourMOSTRECENTPSYCHOLOGICAL/ACADEMICEVALUATIONinitsplace.
ApplicantName:Fall,201712FloridaAtlanticUniversityAcademyforCommunityInclusionHighSchoolTranscriptRemovethisblankpageandinsertyourHIGHSCHOOLTRANSCRIPTinitsplace.
Note:Yourhighschooltranscriptshouldindicatethatyouhavegraduatedorcompletedhighschool.
Thisisanimportantrequirementforthisprogram.
Youmusthavecompletedhighschoolandexitedthepublicschoolsystem.
ApplicantName:Fall,201713FloridaAtlanticUniversityAcademyforCommunityInclusionRecentPhoto/HeadshotofStudentRemovethisblankpageandinsertaRECENTPHOTOofyourselfinitsplace.
ApplicantName:FloridaAtlanticUniversityAcademyforCommunityInclusionFall,201714LetterofRecommendation#1NameofApplicant:TheapplicantisapplyingforadmissiontoFAUAcademyforCommunityInclusion.
TheFAUAcademyforCommunityInclusionisacomprehensivetransitionprogramforindividualswithintellectualanddevelopmentaldisabilities.
Studentswillhavetheopportunitytodeveloptheiracademic,vocational,andsocialskillsatthepost-secondarylevel.
Withinyourletterofrecommendation,pleaseincludethefollowinginformation:YournameandcontactinformationYourrelationshiptotheapplicantLengthoftimeyouhaveknowntheapplicantTheapplicant'smostpositivetraitsAreasthatcouldbedevelopedorimproveduponConcernsyouhaveabouttheapplicantincollegeReasonswhythisapplicantisorisnotagoodcandidateforapostsecondaryprogram.
***Pleasereturnthisformalongwithyoursignedletterofrecommendationinasealedenvelopewithyoursignatureacrossthesealtotheapplicant.
Alllettersofrecommendationareconfidential.
Theapplicantwillsubmitthereferenceletterwiththeircompletedapplicationpacket.
ThankyouforyoursupportoftheFAUAcademyforCommunityInclusion.
FAUAcademyforCommunityInclusionCollegeofEducationEducationClassroomBuilding(EC202)5353ParksideDriveJupiter,FL33458ApplicantName:FloridaAtlanticUniversityAcademyforCommunityInclusionFall,201715LetterofRecommendation#2NameofApplicant:NameofApplicant:TheapplicantisapplyingforadmissiontoFAUAcademyforCommunityInclusion.
TheFAUAcademyforCommunityInclusionisacomprehensivetransitionprogramforindividualswithintellectualanddevelopmentaldisabilities.
Studentswillhavetheopportunitytodeveloptheiracademic,vocational,andsocialskillsatthepost-secondarylevel.
Withinyourletterofrecommendation,pleaseincludethefollowinginformation:YournameandcontactinformationYourrelationshiptotheapplicantLengthoftimeyouhaveknowntheapplicantTheapplicant'smostpositivetraitsAreasthatcouldbedevelopedorimproveduponConcernsyouhaveabouttheapplicantincollegeReasonswhythisapplicantisorisnotagoodcandidateforapostsecondaryprogram.
***Pleasereturnthisformalongwithyoursignedletterofrecommendationinasealedenvelopewithyoursignatureacrossthesealtotheapplicant.
Alllettersofrecommendationareconfidential.
Theapplicantwillsubmitthereferenceletterwiththeircompletedapplicationpacket.
ThankyouforyoursupportoftheFAUAcademyforCommunityInclusion.
FAUAcademyforCommunityInclusionCollegeofEducationEducationClassroomBuilding(EC202)5353ParksideDriveJupiter,FL33458ApplicantName:FloridaAtlanticUniversityAcademyforCommunityInclusionFall,201716LetterofRecommendation#3NameofApplicant:TheapplicantisapplyingforadmissiontoFAUAcademyforCommunityInclusion.
TheFAUAcademyforCommunityInclusionisacomprehensivetransitionprogramforindividualswithintellectualanddevelopmentaldisabilities.
Studentswillhavetheopportunitytodeveloptheiracademic,vocational,andsocialskillsatthepost-secondarylevel.
Withinyourletterofrecommendation,pleaseincludethefollowinginformation:YournameandcontactinformationYourrelationshiptotheapplicantLengthoftimeyouhaveknowntheapplicantTheapplicant'smostpositivetraitsAreasthatcouldbedevelopedorimproveduponConcernsyouhaveabouttheapplicantincollegeReasonswhythisapplicantisorisnotagoodcandidateforapostsecondaryprogram.
***Pleasereturnthisformalongwithyoursignedletterofrecommendationinasealedenvelopewithyoursignatureacrossthesealtotheapplicant.
Alllettersofrecommendationareconfidential.
Theapplicantwillsubmitthereferenceletterwiththeircompletedapplicationpacket.
ThankyouforyoursupportoftheFAUAcademyforCommunityInclusion.
FAUAcademyforCommunityInclusionCollegeofEducationEducationClassroomBuilding(EC202)5353ParksideDriveJupiter,FL33458ApplicantName:Fall,201722FloridaAtlanticUniversityAcademyforCommunityInclusionPersonalStatementVideoEachapplicantmustsubmita3to5-minutedigitalvideo.
Submitthevideoonaflashdriveintheapplicationenvelope.
Thepersonalstatementvideomustinclude:1.
Yourname2.
Thereasonyouhopetoparticipateinthisprogram.
3.
WhatyouhopetolearnwhileatFAU.
4.
Yourgoalsforthefuture.
5.
Adescriptionofyourfavoritesocial/recreationalactivity.
6.
Anythingelsethattheapplicantwouldliketosharewiththeadmissionscommittee.
ApplicantName:Fall,201723FloridaAtlanticUniversityAcademyforCommunityInclusionApplicantContractI,,understandthatcollegestudentsintheFAUAcademyforCommunityInclusionmustabidebythefollowingtermsandconditions:IwillfollowtheFloridaAtlanticUniversityStudentCodeofConduct.
Ohttps://www.
fau.
edu/studentconduct/Student%20Conduct%202012.
pdfIwillfollowmycourseschedule;attendclasses,andcompletecourseassignmentstothebestofmyability.
Iwilljoinandparticipateinonestudentorganizationeachyear.
Iwillcall/textmyinstructorwhenIwillbeabsentorlate.
IunderstandthatIamresponsibleforalltuition,fees,andrelatedexpenses.
IunderstandthatIamresponsiblefortransportationtoandfromFAU.
IwillfollowalltherulesestablishedbyFAUAcademyforCommunityInclusion.
Iwillattendscheduledmeetingswithmyadvisor,andprogramstaff.
Iwillbeanactiveparticipantandcommunicateanyissuesatourmeetings.
Iunderstandthatthefirstsemesterisaprobationarysemester,andcontinuingintheprogramwilldependonmyworkandeffortthroughoutthesemester.
IhavereadtheaboveandunderstandthatthisprogramisvoluntaryandImustagreetothesetermsforacceptanceintoFAUAcademyforCommunityInclusion.
ApplicantSignatureDateApplicantName:Fall,201724FloridaAtlanticUniversityAcademyforCommunityInclusionParent/GuardianMemorandumofUnderstandingTheFAUAcademyforCommunityInclusionisapostsecondarytransitionprogram.
TheAcademyisdesignedforadultswithintellectualanddevelopmentaldisabilitieswhohavecompletedhighschoolandreceivedastateissueddiploma.
TheAcademyisaneligibilityprogram,anditfollowstheFAUAcademyforCommunityInclusion'sproceduresregardingacceptance,continuanceandexitingofstudents.
ThosepoliciesarelocatedintheAcademy'sStudenthandbook.
TheAcademyoperatesinaninclusiveandintegrateduniversitysetting.
StudentsintheAcademyareFAUstudentsfirst,andAcademystudentssecond.
TheAcademyforCommunityInclusionprovidesthefollowingtostudents:PersonCenteredPlanningAcademicAdvisingAcademic,Social,andWellnessMentoringCareerAwarenessandDevelopmentFinancialLiteracyTrainingCampusInclusionandMembershipSelf-DeterminationandIndependentLivingSkillsEnhancementItisthegoaltoprovidestudentswithanauthenticcollegeexperience.
Therefore,theAcademyforCommunityInclusiondoesnotprovidethefollowing:24/7supervisionAone-on-onecompanion/helperwhileoncampusDaily/WeeklyreportsregardingstudentprogressIndividualized,therapeuticbehavioralsupportsIndividualized,therapeuticmentalhealthcounselingInaddition,TheAcademyforCommunityInclusionisnotresponsibleforthefollowing:Students'personalbelongingsPersonalfinancesandmoniesDietoncampusStudentconductApplicantName:Fall,201725GuaranteeingpaidemploymentduringoruponexitingtheprogramTheprogramwillexpectahighleveloffamilysupportregardingthemission,philosophy,andgoalsoftheAcademy.
Asparent(s)/guardian,youneedtoclearlyunderstandtheexpectationsandagreetothelimitationoftheprogramtoprovidedirectteachercontact/supervisionofthestudentsenrolled.
Someopportunitiesprovidedbytheprogrammayoccurbeyondthehoursofatraditionalcollegeday/weekandmayoccurofftheFAUcampus.
Theprogramrequirementsofstudentsinclude,butarenotlimitedto:StudentsmustbeindependentlymobilearoundcampusStudentmustarrangeALLtransportationtoandfromschool/work/FAUandAcademyactivitiesStudentmustbeabletomanageandadheretoallofhisorherscheduleParent/studentmustprovideowncellphoneforusewhenoncampus(mustbeactivatedandon)StudentmustbemotivatedandwillingtoparticipateincampusactivitiesStudent/familyresponsibleforALLfees(e.
g.
tuition,books,supplies,meals,etc.
).
TheFAUAcademyInclusionoffersauniqueopportunityforselectedstudentstogrow,learn,andmoveintoadultlifeinthemostnaturalsetting—acollegecampus.
AnindividualizedFlightPlanisusedtodesignthecourseofstudy,lifeskills,recreation,personalwellness,andcareerdevelopmentopportunitiesforeachstudent.
However,beawarethatsupportsandserviceswillonlybeavailablethatsupporttheprogram'sstatedobjective,whichistopreparestudentstotransitionintoadultlifeasindependentlyaspossible.
ItmustberecognizedthattheFAUAcademyforCommunityInclusionisanon-degreeprogram.
However,studentswillearncreditstowardcertificatesrecognizedbytheUniversityasaccomplishmentsintheirownrights.
I(we)understandthatifisacceptedintotheprogramthatwewillprovidethenecessaryparentalsupportandweareawarethats/hewillnotbeinthepresenceoftheAcademystaffmostofthetimeduringtheschooldays.
TherearerisksassociatedI(we)understandthatanyprogramprovidedtotallyinthecommunity,andI(we)arewillingtoacceptthoserisksanddonotholdFAUortheiremployeesliable.
ApplicantName:Fall,201726I(we)understandthatthefirstsemesterintheAcademy,isaprobationarysemester,andcontinuingintheprogramwilldependonindividualworkandeffortthroughoutthesemester.
Parent/Guardian/CaregiverName:Parent/Guardian/CaregiverSignature:DateSigned:ApplicantName:Fall,201727FloridaAtlanticUniversityAcademyforCommunityInclusionResearchConsentThegoalofTheFAUAcademyforCommunityInclusionisto:AssiststudentstobecomelifelonglearnersconnectedtotheircommunityAssiststudentstoincreasetheirpersonallevelofindependenceAssiststudentstoprepareforworkItisimportantforfuturefunding,thatwedocumentthesuccessofthestudentsduringanduponexitingtheprogram.
Therefore,eachstudentisbeingaskedtoagreetoparticipateinvariousshort-termandalongitudinalstudies.
Informationwillbegathered,monitored,anddocumentedduringeachstudent'stimeenrolledatFAU.
Bysigningthisdocument,theapplicantsandtheirfamiliesacknowledgethefactthats/hewillbepartofanon-goingresearchprojectandagreesthatiftheyareselectedfortheprogramthattheyarewillingtoparticipateintheresearchbothduringenrollmentatFAUaswellasfollowinggraduation.
StudentSignatureDate:Parent(s)/Guardian(s)Signature(s):Date:Date:ApplicantName:Fall,201728FloridaAtlanticUniversityAcademyforCommunityInclusionPhoto/MediaReleaseFormAUTHORIZATIONTOUSEWRITTENMATERIALS/PHOTOGRAPHS/VIDEOSStudentNameIherebyauthorizetheFAUAcademyforCommunityInclusiontouse,reproduce,and/orpublishallwrittenand/orvisualmaterials,includingphotographsandvideothatmaypertaintome/mysonordaughter.
Iunderstandthatthismaterialmaybeusedinvariouspublications,publicitypresentations,recruitmentmaterials,orforothereducationalpurposes.
ThismaterialmayalsoappearontheFloridaAtlanticUniversityWebsite.
IalsounderstandthatonceanimageispostedontheFloridaAtlanticUniversity,anycomputeruseronoroffcampuscanviewtheimage.
Thisauthorizationiscontinuousandmayonlybewithdrawnbymyspecificrescissionofthisauthorization.
Idoauthorizetheuseofwrittenmaterials/photographs/videos.
Idonotauthorizetheuseofwrittenmaterials/photographs/videos.
Applicant'sSignature:_Date:Parent(s)/Guardian(s)Signature(s):Date:Date:
Studentswillhavetheopportunitytodeveloptheiracademic,vocationalandsocialskillsatthepost-secondarylevel.
Thecoursesandcertificatesofferedarebasedonthestrengthsandneedsoftheindividualparticipant.
TheprogramishousedontheJupiterCampusofFloridaAtlanticUniversity.
EligibilityCriteriaApplicantsmust…HaveadocumentedintellectualanddevelopmentaldisabilityBeatleast18yearsoldHavegraduatedorcompletedhighschool(canprovideatranscriptindicatingcompletion)BecapableofmeetingpersonalneedswithoutassistanceBeabletoself-administeranynecessarymedicationHavenobehaviordifficultiesHavethecapabilitytoparticipatein50to90minuteclassesNavigatethecampusindependentlyHavethedesiretoparticipateinacollegeprogram.
ApplicationProcess1.
ApplytotheFAUAcademyforCommunityInclusionbycompletingthispacket.
2.
WhenyouhavecompletedtheAcademyforCommunityInclusionapplicationdeliveryittoFAUJupiterCollegeofEducation:ECBuildingroom202ormailitusingtheaddressonpage3ofthisapplication.
Incompleteapplicationwillnotbeincludedintheapplicantreviewprocess.
3.
Qualifiedapplicantsareinvitedforastudentandfamilyinterview.
4.
ApplicantsarenotifiedbymailofacceptancetotheprogramandwillthenneedtosubmitanapplicationtoFAU.
ApplicantName:Fall,20173FloridaAtlanticUniversityAcademyforCommunityInclusionApplicationChecklist1.
CompletedAcademyforCommunityInclusionApplicantPacket2.
CopyofmostrecentIndividualEducationPlan(IEP)3.
Copyofmostrecentpsychologicaloracademicevaluation4.
Highschooltranscriptshowingproofofgraduation5.
Recentphoto/headshotofapplicant6.
Three(3)lettersofrecommendation:two(2)shouldbeprofessionalandone(1)personal7.
Personalvideostatement(digitalcopyoftheapplicant'sresponsestoquestionsonpage22ofthisapplication8.
Signedapplicantcontract9.
SignedParent/Guardian/Caretakermemorandumofunderstanding10.
Signedreleaseofinformationform11.
Signedphoto/mediareleaseform12.
SignedFERPAwaiverSendordelivertheCOMPLETEDApplicationPacketto:FAUAcademyforCommunityInclusionCollegeofEducationEducation/ClassroomBuilding(EC202)5353ParksideDriveJupiter,FL33458***DeadlineforFall,2017ApplicationsisJune15th,2017PleasesendquestionstoACI@fau.
eduApplicantName:Fall,20174DearFAUAcademyforCommunityInclusionApplicant:Weareveryexcitedtobeabletoofferthisprogramtoyouasanoptionforapathwaytoindependence.
TheAcademywillgiveyouachancetogotocollegewithsomecollegestudentswhoareyourage,andsomewhomightevenbeolder.
FAU'sMacArthurCampusisverydiverse.
That'sonereasonthatitistheperfectplacetobeginyourcollegecareer.
AsanFAUAcademyforCommunityStudentyouareanFAUstudentfirst.
YouwillhaveanOWLCard,takepartincampusevents,andgotostudentactivities,footballgames,andconcerts.
EverythingthatanyonewoulddoasastudentatFAU.
Itisnotallfunandgames,however.
TheAcademyforCommunityInclusionisacombinationofcollegecourses,workexperiences,collegelife,aswellascollegecampusactivities.
TheprogramofferschallengingcoursesthatleadtocertificationsinSupportedEmployment,SupportedCommunityAccess,andSupportedCommunityLiving.
Thegoalofeachcertificateprogramistobuildself-determinationskillsintoeachcourse.
Bythat,wemeanthatyouwilllearnaboutyourownstrengthsandaboutthethingsyouhaveaccomplished.
Youwillbetterunderstandthewayyouhandlechallengesandthestrategiesthatworkbestforyou.
ThecertificateinSupportedEmploymentwillleadtoworkexperiences,beginningoncampusandthenmovingoutintothenearbycommunityandfinallytoacompetitivejob.
ThecertificateinSupportedCommunityAccesswillprovideyouwiththeskillstomoveaboutthecommunityasindependentlyaspossible.
Youwilllearnhowtotravelusingvariousmodesoftransportation,howtomanageschedules,andhowtobesafewhileyouaretraveling.
ThecertificateinSupportedCommunityLivingwillimproveyourindependentlivingskillsandhelptransitiontoamoreindependentlifestyle.
Youcanworkononeorallthreeofthecertificates.
Thisisanimportantstepforyou.
Onethatshouldbetakenveryseriously.
Asyoufillouttheapplication,thinkabouthowimportantitistotaketheprocessveryseriouslyandhonestly.
Readallthedirectionsandcompletethepacketbeforeyouturnitin.
Wewillinterviewfinalistapplicantsaspartoftheprocess.
Ihopewewillmeetyoufacetofaceverysoon.
Sincerely,Dr.
MaryLouiseDuffyProfessorandACIProjectCoordinatorApplicantName:Fall,20175ApplicantInformationLastNameFirstNameMiddleNameDateofBirthGenderStreetAddressCityStateZipCodeHomePhoneCellPhoneEmailAddressHowdidyouhearaboutourprogramIcurrentlylive.
.
.
.
.
.
Withmyfamily/parentsGroupHomeIndependentlyOtherIgetaroundtown…(Checkallthatapplytoyou)WithmyfamilyUsingpublictransportationBydrivingmyselfOtherBywalkingApplicantName:Fall,20176EducationHistorySchoolNameCity,StateYearsAttendedWhatwereyourfavoritesubjectsinhighschoolWhatsubjectsinhighschoolwerethemostdifficultforyouHowdoyoulearnbest(smallgroups,handson,etc.
)ApplicantName:Fall,20177EmploymentHistoryEmployerJobResponsibilitiesDatesVolunteerSiteResponsibilitiesDatesWhatworkexperiencesdoyouhaveaninterestinorenjoyWhattypeofjobdoyouhopetohaveinthefutureApplicantName:Fall,20178Guardian#1FamilyInformationLastNameFirstNameMIRelationshiptoStudentHomePhoneCellPhoneEmployerBusinessPhoneStreetAddressCityStateZipEmailAddressGuardian#2LastNameFirstNameMIRelationshiptoStudentHomePhoneCellPhoneEmployerBusinessPhoneStreetAddressCityStateZipEmailAddressSiblingNameAgePhoneApplicantName:Fall,20179MEDICATIONINFORMATIONMedicalConditions***GlassesYes()No()ContactsYes()No()HearingaidsYes()No()DoyouhaveanyphysicaldisabilitiesorlimitationsthatweneedtobeawareofforthisprogramPleasedescribe.
Doyouhaveanymedicalconcernsthatweshouldbeawareofforthisprogram(Asthma,ADHD,Seizures)DoyouhaveanyallergiesPleaselistallergensandseverity.
Doyourequireattendantcareforpersonalneeds***Ifadmitted,theFAUAcademyforCommunityInclusionwillrequiredetailedinformationregardingmedicationinsuranceandemergencycontacts.
Doyoutakemedication(s)Yes()No()DoyouneedassistancewithtakingyourmedicationYes()No()DoyourequirephysicalsupportsMarkallthatapplytoyou.
UsesamanualwheelchairYes()UsesanelectricwheelchairYes()UsesawalkerYes()UsesacaneYes()Useshandrailsinthebathroom/showerYes()HowdoyouhandleyourownphysicallimitationsApplicantName:Fall,201710FloridaAtlanticUniversityAcademyforCommunityInclusionIndividualEducationPlanRemovethisblankpageandinsertyourMOSTRECENTIEPinitsplace.
ApplicantName:Fall,201711FloridaAtlanticUniversityAcademyforCommunityInclusionPsychological/AcademicEvaluationRemovethisblankpageandinsertyourMOSTRECENTPSYCHOLOGICAL/ACADEMICEVALUATIONinitsplace.
ApplicantName:Fall,201712FloridaAtlanticUniversityAcademyforCommunityInclusionHighSchoolTranscriptRemovethisblankpageandinsertyourHIGHSCHOOLTRANSCRIPTinitsplace.
Note:Yourhighschooltranscriptshouldindicatethatyouhavegraduatedorcompletedhighschool.
Thisisanimportantrequirementforthisprogram.
Youmusthavecompletedhighschoolandexitedthepublicschoolsystem.
ApplicantName:Fall,201713FloridaAtlanticUniversityAcademyforCommunityInclusionRecentPhoto/HeadshotofStudentRemovethisblankpageandinsertaRECENTPHOTOofyourselfinitsplace.
ApplicantName:FloridaAtlanticUniversityAcademyforCommunityInclusionFall,201714LetterofRecommendation#1NameofApplicant:TheapplicantisapplyingforadmissiontoFAUAcademyforCommunityInclusion.
TheFAUAcademyforCommunityInclusionisacomprehensivetransitionprogramforindividualswithintellectualanddevelopmentaldisabilities.
Studentswillhavetheopportunitytodeveloptheiracademic,vocational,andsocialskillsatthepost-secondarylevel.
Withinyourletterofrecommendation,pleaseincludethefollowinginformation:YournameandcontactinformationYourrelationshiptotheapplicantLengthoftimeyouhaveknowntheapplicantTheapplicant'smostpositivetraitsAreasthatcouldbedevelopedorimproveduponConcernsyouhaveabouttheapplicantincollegeReasonswhythisapplicantisorisnotagoodcandidateforapostsecondaryprogram.
***Pleasereturnthisformalongwithyoursignedletterofrecommendationinasealedenvelopewithyoursignatureacrossthesealtotheapplicant.
Alllettersofrecommendationareconfidential.
Theapplicantwillsubmitthereferenceletterwiththeircompletedapplicationpacket.
ThankyouforyoursupportoftheFAUAcademyforCommunityInclusion.
FAUAcademyforCommunityInclusionCollegeofEducationEducationClassroomBuilding(EC202)5353ParksideDriveJupiter,FL33458ApplicantName:FloridaAtlanticUniversityAcademyforCommunityInclusionFall,201715LetterofRecommendation#2NameofApplicant:NameofApplicant:TheapplicantisapplyingforadmissiontoFAUAcademyforCommunityInclusion.
TheFAUAcademyforCommunityInclusionisacomprehensivetransitionprogramforindividualswithintellectualanddevelopmentaldisabilities.
Studentswillhavetheopportunitytodeveloptheiracademic,vocational,andsocialskillsatthepost-secondarylevel.
Withinyourletterofrecommendation,pleaseincludethefollowinginformation:YournameandcontactinformationYourrelationshiptotheapplicantLengthoftimeyouhaveknowntheapplicantTheapplicant'smostpositivetraitsAreasthatcouldbedevelopedorimproveduponConcernsyouhaveabouttheapplicantincollegeReasonswhythisapplicantisorisnotagoodcandidateforapostsecondaryprogram.
***Pleasereturnthisformalongwithyoursignedletterofrecommendationinasealedenvelopewithyoursignatureacrossthesealtotheapplicant.
Alllettersofrecommendationareconfidential.
Theapplicantwillsubmitthereferenceletterwiththeircompletedapplicationpacket.
ThankyouforyoursupportoftheFAUAcademyforCommunityInclusion.
FAUAcademyforCommunityInclusionCollegeofEducationEducationClassroomBuilding(EC202)5353ParksideDriveJupiter,FL33458ApplicantName:FloridaAtlanticUniversityAcademyforCommunityInclusionFall,201716LetterofRecommendation#3NameofApplicant:TheapplicantisapplyingforadmissiontoFAUAcademyforCommunityInclusion.
TheFAUAcademyforCommunityInclusionisacomprehensivetransitionprogramforindividualswithintellectualanddevelopmentaldisabilities.
Studentswillhavetheopportunitytodeveloptheiracademic,vocational,andsocialskillsatthepost-secondarylevel.
Withinyourletterofrecommendation,pleaseincludethefollowinginformation:YournameandcontactinformationYourrelationshiptotheapplicantLengthoftimeyouhaveknowntheapplicantTheapplicant'smostpositivetraitsAreasthatcouldbedevelopedorimproveduponConcernsyouhaveabouttheapplicantincollegeReasonswhythisapplicantisorisnotagoodcandidateforapostsecondaryprogram.
***Pleasereturnthisformalongwithyoursignedletterofrecommendationinasealedenvelopewithyoursignatureacrossthesealtotheapplicant.
Alllettersofrecommendationareconfidential.
Theapplicantwillsubmitthereferenceletterwiththeircompletedapplicationpacket.
ThankyouforyoursupportoftheFAUAcademyforCommunityInclusion.
FAUAcademyforCommunityInclusionCollegeofEducationEducationClassroomBuilding(EC202)5353ParksideDriveJupiter,FL33458ApplicantName:Fall,201722FloridaAtlanticUniversityAcademyforCommunityInclusionPersonalStatementVideoEachapplicantmustsubmita3to5-minutedigitalvideo.
Submitthevideoonaflashdriveintheapplicationenvelope.
Thepersonalstatementvideomustinclude:1.
Yourname2.
Thereasonyouhopetoparticipateinthisprogram.
3.
WhatyouhopetolearnwhileatFAU.
4.
Yourgoalsforthefuture.
5.
Adescriptionofyourfavoritesocial/recreationalactivity.
6.
Anythingelsethattheapplicantwouldliketosharewiththeadmissionscommittee.
ApplicantName:Fall,201723FloridaAtlanticUniversityAcademyforCommunityInclusionApplicantContractI,,understandthatcollegestudentsintheFAUAcademyforCommunityInclusionmustabidebythefollowingtermsandconditions:IwillfollowtheFloridaAtlanticUniversityStudentCodeofConduct.
Ohttps://www.
fau.
edu/studentconduct/Student%20Conduct%202012.
pdfIwillfollowmycourseschedule;attendclasses,andcompletecourseassignmentstothebestofmyability.
Iwilljoinandparticipateinonestudentorganizationeachyear.
Iwillcall/textmyinstructorwhenIwillbeabsentorlate.
IunderstandthatIamresponsibleforalltuition,fees,andrelatedexpenses.
IunderstandthatIamresponsiblefortransportationtoandfromFAU.
IwillfollowalltherulesestablishedbyFAUAcademyforCommunityInclusion.
Iwillattendscheduledmeetingswithmyadvisor,andprogramstaff.
Iwillbeanactiveparticipantandcommunicateanyissuesatourmeetings.
Iunderstandthatthefirstsemesterisaprobationarysemester,andcontinuingintheprogramwilldependonmyworkandeffortthroughoutthesemester.
IhavereadtheaboveandunderstandthatthisprogramisvoluntaryandImustagreetothesetermsforacceptanceintoFAUAcademyforCommunityInclusion.
ApplicantSignatureDateApplicantName:Fall,201724FloridaAtlanticUniversityAcademyforCommunityInclusionParent/GuardianMemorandumofUnderstandingTheFAUAcademyforCommunityInclusionisapostsecondarytransitionprogram.
TheAcademyisdesignedforadultswithintellectualanddevelopmentaldisabilitieswhohavecompletedhighschoolandreceivedastateissueddiploma.
TheAcademyisaneligibilityprogram,anditfollowstheFAUAcademyforCommunityInclusion'sproceduresregardingacceptance,continuanceandexitingofstudents.
ThosepoliciesarelocatedintheAcademy'sStudenthandbook.
TheAcademyoperatesinaninclusiveandintegrateduniversitysetting.
StudentsintheAcademyareFAUstudentsfirst,andAcademystudentssecond.
TheAcademyforCommunityInclusionprovidesthefollowingtostudents:PersonCenteredPlanningAcademicAdvisingAcademic,Social,andWellnessMentoringCareerAwarenessandDevelopmentFinancialLiteracyTrainingCampusInclusionandMembershipSelf-DeterminationandIndependentLivingSkillsEnhancementItisthegoaltoprovidestudentswithanauthenticcollegeexperience.
Therefore,theAcademyforCommunityInclusiondoesnotprovidethefollowing:24/7supervisionAone-on-onecompanion/helperwhileoncampusDaily/WeeklyreportsregardingstudentprogressIndividualized,therapeuticbehavioralsupportsIndividualized,therapeuticmentalhealthcounselingInaddition,TheAcademyforCommunityInclusionisnotresponsibleforthefollowing:Students'personalbelongingsPersonalfinancesandmoniesDietoncampusStudentconductApplicantName:Fall,201725GuaranteeingpaidemploymentduringoruponexitingtheprogramTheprogramwillexpectahighleveloffamilysupportregardingthemission,philosophy,andgoalsoftheAcademy.
Asparent(s)/guardian,youneedtoclearlyunderstandtheexpectationsandagreetothelimitationoftheprogramtoprovidedirectteachercontact/supervisionofthestudentsenrolled.
Someopportunitiesprovidedbytheprogrammayoccurbeyondthehoursofatraditionalcollegeday/weekandmayoccurofftheFAUcampus.
Theprogramrequirementsofstudentsinclude,butarenotlimitedto:StudentsmustbeindependentlymobilearoundcampusStudentmustarrangeALLtransportationtoandfromschool/work/FAUandAcademyactivitiesStudentmustbeabletomanageandadheretoallofhisorherscheduleParent/studentmustprovideowncellphoneforusewhenoncampus(mustbeactivatedandon)StudentmustbemotivatedandwillingtoparticipateincampusactivitiesStudent/familyresponsibleforALLfees(e.
g.
tuition,books,supplies,meals,etc.
).
TheFAUAcademyInclusionoffersauniqueopportunityforselectedstudentstogrow,learn,andmoveintoadultlifeinthemostnaturalsetting—acollegecampus.
AnindividualizedFlightPlanisusedtodesignthecourseofstudy,lifeskills,recreation,personalwellness,andcareerdevelopmentopportunitiesforeachstudent.
However,beawarethatsupportsandserviceswillonlybeavailablethatsupporttheprogram'sstatedobjective,whichistopreparestudentstotransitionintoadultlifeasindependentlyaspossible.
ItmustberecognizedthattheFAUAcademyforCommunityInclusionisanon-degreeprogram.
However,studentswillearncreditstowardcertificatesrecognizedbytheUniversityasaccomplishmentsintheirownrights.
I(we)understandthatifisacceptedintotheprogramthatwewillprovidethenecessaryparentalsupportandweareawarethats/hewillnotbeinthepresenceoftheAcademystaffmostofthetimeduringtheschooldays.
TherearerisksassociatedI(we)understandthatanyprogramprovidedtotallyinthecommunity,andI(we)arewillingtoacceptthoserisksanddonotholdFAUortheiremployeesliable.
ApplicantName:Fall,201726I(we)understandthatthefirstsemesterintheAcademy,isaprobationarysemester,andcontinuingintheprogramwilldependonindividualworkandeffortthroughoutthesemester.
Parent/Guardian/CaregiverName:Parent/Guardian/CaregiverSignature:DateSigned:ApplicantName:Fall,201727FloridaAtlanticUniversityAcademyforCommunityInclusionResearchConsentThegoalofTheFAUAcademyforCommunityInclusionisto:AssiststudentstobecomelifelonglearnersconnectedtotheircommunityAssiststudentstoincreasetheirpersonallevelofindependenceAssiststudentstoprepareforworkItisimportantforfuturefunding,thatwedocumentthesuccessofthestudentsduringanduponexitingtheprogram.
Therefore,eachstudentisbeingaskedtoagreetoparticipateinvariousshort-termandalongitudinalstudies.
Informationwillbegathered,monitored,anddocumentedduringeachstudent'stimeenrolledatFAU.
Bysigningthisdocument,theapplicantsandtheirfamiliesacknowledgethefactthats/hewillbepartofanon-goingresearchprojectandagreesthatiftheyareselectedfortheprogramthattheyarewillingtoparticipateintheresearchbothduringenrollmentatFAUaswellasfollowinggraduation.
StudentSignatureDate:Parent(s)/Guardian(s)Signature(s):Date:Date:ApplicantName:Fall,201728FloridaAtlanticUniversityAcademyforCommunityInclusionPhoto/MediaReleaseFormAUTHORIZATIONTOUSEWRITTENMATERIALS/PHOTOGRAPHS/VIDEOSStudentNameIherebyauthorizetheFAUAcademyforCommunityInclusiontouse,reproduce,and/orpublishallwrittenand/orvisualmaterials,includingphotographsandvideothatmaypertaintome/mysonordaughter.
Iunderstandthatthismaterialmaybeusedinvariouspublications,publicitypresentations,recruitmentmaterials,orforothereducationalpurposes.
ThismaterialmayalsoappearontheFloridaAtlanticUniversityWebsite.
IalsounderstandthatonceanimageispostedontheFloridaAtlanticUniversity,anycomputeruseronoroffcampuscanviewtheimage.
Thisauthorizationiscontinuousandmayonlybewithdrawnbymyspecificrescissionofthisauthorization.
Idoauthorizetheuseofwrittenmaterials/photographs/videos.
Idonotauthorizetheuseofwrittenmaterials/photographs/videos.
Applicant'sSignature:_Date:Parent(s)/Guardian(s)Signature(s):Date:Date:
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