Project SEARCH® Arkansas: ACCESS Initiative Application - Adult Program

Program Information

PERSONAL DATA

Applicant Contact Information

If you do not have an email address, please provide the email of a parent or guardian.

MUST be 18 by program start date.

Parent Contact Information

Guardian Contact Information

You will be required to provide legal documentation of guardianship if you are accepted into the program.

Funding Information

Education Background

If you have graduated from high school please complete this section

If you have not graduated from high school then please complete this section

Work Background

List jobs (paid or unpaid) you currently do or have done in school or in the community

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Transportation

How do you plan to get to your Project SEARCH program location?

Diagnosis/Symptoms

Additional Data

Reference Information

Please provide the name and contact information of a non-related individual to complete an applicant assessment. (Example: previous employer, teacher, neighbor, etc.)

Application Compliance

Applicant's position within the program is contingent upon adherence to the policies and procedures of Project SEARCH Arkansas: ACCESS Initiative. By signing, the applicant and/or guardian agree to comply

Terms and Conditions

* I understand that if I am accepted into the Project Search Arkansas: ACCESS Initiative Program, I must abide by the following terms and conditions:

* I understand that the Project SEARCH program is a nine-month work/educational program, and I will actively pursue competitive employment when I have completed the program.

* I will complete at least three unpaid intern rotations at a Project SEARCH program location.

* I will attend the program every day as scheduled.

* I understand that the Project SEARCH program correlates with the ACCESS Academy academic calendar.

* I will dress appropriately and wear required attire.

*I will call my instructor when I will be absent or tardy.

*I understand that I am responsible for transportation to and from my Project SEARCH program location.

* I will follow all rules established by the program.

* I will attend and be an active participant at meetings with my rehabilitation counselor, parents, instructors and staff.

. * I will be up to date on all needed immunizations.

. * I will be able to pass a felony background check.

* I will receive a TB Skin Test and Flu Shot.

* I will remain drug and nicotine free through out the program.