OASIS Program at Mercyhurst North East 16 West Division Street, North East, PA

Transcription

1 OASIS PROGRAM Application for admission OASIS Program at Mercyhurst North East 16 West Division Street, North East, PA Mercyhurst North East is an opportunity college that takes pride in its approach to a value-centered education. The diverse backgrounds of our students are what make us strong, and we welcome your admission with the hope that we may assist you in preparing you to successfully manage future challenges in all facets of your life. This application is designed to assist our admissions committee in understanding your educational background, academic and vocational goals and unique qualities. After completing the application, return it to the address above. If you have any questions about this application or the OASIS Program, please call The OASIS Program is sponsored, in part, through a grant made available by the DREAM Partnership and OVR s ACES Project. Please print or type when completing this form. Please include information related to the applicant within the personal information section. PERSONAL INFORMATION Social Security Number: - - Male Female Name: Last First Maiden/Other Mailing Address: City: State: Zip: County: PA Residents Only Home Phone: Cell: Birth Date: Month Day Year Marital Status: Single Separated Married Spouse s Name: Citizenship: U.S. Citizen U.S./Dual Citizenship U.S. Permanent Resident: # A Other, please specify country RELEASE OF INFORMATION Please document the name(s) of anyone who you authorize to engage in communication regarding your application to the OASIS Program. For example, if you would like a parent or guardian to be able to speak with representatives from the program about your application and/or on your behalf during the application process, please write their name below. Name Relationship

2 ENROLLMENT INFORMATION The OASIS Program is a one- or two-year, proficiency-based certificate program for people with intellectual and/or developmental disabilities. Students who attend the OASIS Program typically had an IEP or 504 plan in school. They do not meet the general admissions requirements for Mercyhurst University s traditional degree or certificate programs or they feel strongly that they would not be successful in pursuing such a degree. The program begins in the fall of every school year. After the academic portion of the program, students complete a 60- hour internship. Students and relevant adults are responsible for collaborating with OASIS staff. Please mark the certificate area that you are interested in: Culinary Arts Hospitality Early Childhood (tentative) Business One-Year Program Two-Year Program Do you plan to live on Mercyhurst s campus while you are in the OASIS Program? (check one): Yes, I would like to live on campus. No, I will be a commuter. HIGH SCHOOL ATTENDED* High School: Year of H.S. graduation: or Date GED Received: Address: City: State: Zip: School Phone: *Please have your high school send your transcript, your most recent IEP or 504 plan, and your most recent Evaluation (or Re-Evaluation) to the OASIS Program. This is required in order for your application to be considered complete. PARENT/GUARDIAN INFORMATION Father s Name: Living Deceased Address: City: State: Zip: Home Phone: Work/Cell Phone: Address: Mother s Name: Living Deceased Address: City: State: Zip: Home Phone: Work/Cell Phone: Address: If you have a guardian, please complete:

3 Name of Guardian: Address: City: State: Zip: INDIVIDUAL SKILL ASSESSMENT Please complete the following self-assessments by marking the box that you think is the most like you. Note: The student applying to the OASIS Program should complete these assessments as independently as possible. Interpersonal Skills Greet people appropriately Communicate needs and opinions to others effectively Engage in informal conversations (small talk) Establish and maintains relationships with friends Engage in social activities Respond appropriately to authority figures Problem solve Recognize and manage my emotions Recognize and respond appropriately to the emotions of others Find when needed Ask questions when I need clarification Work to improve my performance Respond to feedback appropriately Follow single-step written directions (1 step) Follow multi-step written directions (2 or more steps) Follow single-step verbal directions (1 step) Follow multi-step verbal directions (2 or more steps) Please include anything else we should know about your interpersonal skills: Community Integration Skills Cross the street appropriately Use public transportation Contact emergency resources (police, fire department, etc.) Use community resources (library, church, pool, etc.) Demonstrate safety awareness when among strangers Know how to find when I need it Find when I need it Please include anything else we should know about your community integration skills:

4 Supporting Independence in the Community Skills Make my own purchases Use a debit or credit card Follow a weekly (or monthly) budget (can be with an allowance) Make change using bills and coins Manage personal belongings Schedule necessary appointments Use a computer Use Use Facebook and/or other social media Please include anything else we should know about the skills listed above: Independent Living Skills Shower/bathe routinely Demonstrate personal care habits (brush teeth, comb hair) Trim nails Shave Complete morning routine in a timely manner Select appropriate sleep schedules Understand the time needed to complete different tasks (clean room, personal care, homework) Do laundry (uses a washing machine and dryer) Maintain a clean and organized living area Manage personal belongings Manage medications Dress appropriately for the weather or event Please include anything else we should know about the skills listed above:

5 PERSONAL ESSAY In 50 words or less, please tell us why you want to come to the OASIS Program. REFERENCE INFORMATION Please have at least three (3) non-family members complete the application document: Reference Survey (nonfamily/guardian). These references should submit the survey, along with a letter of recommendation, to the OASIS Program. A good reference would be someone who is able to identify your strengths and can speak to why you would be a good fit for the OASIS Program. These surveys are used to us understand your needs and strengths. They give us a better idea of the types of supports you may need if you are accepted into the OASIS Program Please have one family member or guardian complete the application document: Reference Survey (family/guardian). This person should submit the survey to the OASIS Program. They do not have to write a letter of recommendation. A good person to fill out the Reference Survey (family/guardian) would be someone who has lived with you and can speak to your ability to take care of yourself. I understand this application must be complete before any consideration can be given by the Admissions Committee. I understand that credentials filed in support of this application become property of the college and are not returnable to the applicant. I certify that the information supplied on this application is complete and accurate. I further understand that submission of inaccurate or false documentation is grounds for rejection of this application. SIGNATURE: DATE OF APPLICATION: / / Signature of applicant MONTH DAY YEAR

6 APPLICATION PROCESS/Checklist 1) Send completed & signed application to the OASIS Program Office: OASIS Program at Mercyhurst North East 16 West Division Street North East, PA ) Arrange with your high school and/or other previous educational institutions to have your most recent Individualized Education Plan (IEP), Behavior Plan, and/or 504 Plan (and accompanying ER or RR) in addition to your final transcript sent to the OASIS Office. Please complete necessary releases of information as required by issuing institutions. 3) Arrange with any applicable service providers to have appropriate documentation of disability sent to the OASIS Office. This documentation is required from a licensed psychologist, medical professional, or equivalent. Documentation must have been completed within the past three years. If you have questions regarding what qualifies as appropriate documentation, please contact our office. Please complete necessary releases of information as required by issuing institutions. 4) Contact at least three non-family members and have them complete & send in the Reference Survey (non-family/guardian) document. They need to send this to the OASIS Program Office with their letter of recommendation. 5) Have one family member or guardian complete the Reference Survey (family/guardian) document. They need to send this to the OASIS Program Office. Once we have received your application and all of the required components, our Advisory Committee will review the included information. Following the review of application documents, we will invite qualified students for an interview as the next step of the application process. If you have any questions, please contact the OASIS Program at Do not write below this line (for office use only): Application Rec d Date _(initials)_ Application Complete Date _(initials) Signed Application IEP/BP/504/Tx Plan Psych Eval 3 Ref Survey & LOC Family/Guardian Ref Survey Interview Offered yes no (circle one) Interview Date/Time Admission Decision Applicant Notified Initials