Student Application

List a few activities you enjoy in your free time.

What is your diagnosed disability?

How may your disability affect your ability to work?

How does your disability affect your ability to learn?

What supports have your teachers given you that have helped you the most?

Are you usually healthy?

List any health or medical issues.

Do you have a seizure disorder? If yes, when was your last seizure?

List any medications you take. (If you cannot remember the name of the medication just write yes)

How do you wake up in the morning?

Who chooses your clothing in the morning?

Are you able to prepare a simple meal?

Do you stay at home alone? If yes, for how long?

What helps you learn best?

What are some accommodations that might assist you in being successful in a work environment?

Do you have any behaviors that might impact a successful job placement? If yes, please explain:

Have you had any peer/adult interactions that might impact a successful job placement? If YES please explain:

Have you ever been suspended/expelled/removed from the school environment for any reason? If YES, please explain:

How do you handle constructive criticism?

How do you cope with following directions and rules given to you at work and at school?

Do you have a valid Ohio driver’s license?

Do you have a temporary driver's permit?

Have you had driver's training classes?

Do you expect to drive in the future?

If you drive, do you have your own vehicle?

Can you or have you ridden a public bus?

Do you live near a public bus route? If YES, how far from the route?

If you cannot or have not ridden a public bus, are you willing to participate in Travel Training?

When thinking about a job, what are your strengths and skills?

Do you prefer to work with people or by yourself?

Do you enjoy working with computers or equipment?

Do you enjoy a job where you move around or do you prefer to sit at a desk?

What jobs or chores do you do around the house?

List jobs you do or have done in school or in the community.

Which jobs do you like best?

Which jobs do you like the least?

Which jobs are the easiest for you?

Which jobs are the hardest?

List places/activities where you have gained work experience.

Personal Data

Student Goals

Student Information

Transportation

Work History and Job Experiences

Job Skills

Standout Question

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