Fillable 1902TAP Application TAP Application

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1902TAP Application TAP Application

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Access & Disability Services
1200 West Algonquin Road, Room I-103
Palatine, Illinois 60067-7398
847.925.6266, 224.836.5048 vp
1902TAP_Application – RU/AR
TRANSITION AUTISM PROGRAM
STUDENT APPLICATION
Thank you for your interest in the Harper College Transition Autism Program (TAP).
The goals of TAP are to:
Encourage academic success
Improve interpersonal relationships
Increase the likelihood of degree or certificate completion
Improve on-boarding and retention of students
Continually improve services for students on the Autism Spectrum
An application to the TAP program is considered complete when a student meets the following:
1. Graduating (accepting high school diploma) or graduated high school prior to attending Harper
2. Submit completed TAP Application to Access and Disability Services (ADS)
3. Apply to Harper College as a Degree or Certificate-Seeking Student and receive an acceptance letter from
the College
4. Apply and complete an intake with ADS
*To be considered complete, an ADS application should include appropriate documentation,
psychological evaluation, detailing an Autism Spectrum diagnosis, and/or an IEP/504 plan with an
Autism Spectrum diagnosis.
5. Submit ACT/SAT scores to Harper College and/or complete required Harper College Placement Tests.
Placement testing may be waived if the student meets specific ACT or SAT score requirements detailed at
the following link: https://www.harpercollege.edu/registration/testing/courseplacement.php.
6. Send high school transcript to Harper College – Attn: Admissions Processing. (The transcript from high
school must indicate 2.75 out of 4.0 cumulative Grade Point Average or above.)
Once an application is submitted, the student will receive confirmation of receipt. Once an application is
complete, it will be reviewed and an invitation may be extended to interview in-person for the program.
Please mail all application requirements to:
Access and Disability Services
c/o TAP
Harper College
1200 W. Algonquin Road
Palatine, IL 60067-7398
Fax: 847.925.6267, Attention: TAP
Email scanned documents to: projecttap@harpercollege.edu
Questions? Feel free to contact ADS at 847.925.6266 during business hours:
Monday through Thursday, 08:00 AM – 07:00 PM and Fridays, 08:00 AM – 04:30 PM.
2
TRANSITION AUTISM PROGRAM APPLICATION
1. Please enter today’s date:
2. Please enter your first and last name:
3. What is your street address?:
4. What is your city?: 5. State?: 6. Zip code?:
7. What is your home phone number?: 8. Cell phone?:
9. Please enter your email address:
10. What is your gender?:
11. What is your primary language?: English; Other (please specify):
12. What is your Harper ID number?: H00
13. What is your date of birth?:
14. Please select your high school:
Barrington Fremd Schaumburg Christian
Buffalo Grove Hersey Saint Viator
Christian Liberty Hoffman Estates Wheeling
Conant Palatine
D211 Prospect
D214 Rolling Meadows Home School
Elk Grove Schaumburg Other:
15. What is your high school cumulative grade point average (GPA)?:
3
16. When do you plan on starting at Harper?: Spring; Summer; Fall, Year:
18. Did you apply to Harper College?: Yes; No Date:
19. Did you complete an intake with ADS?: Yes; No Date:
20. Please indicate your sources of funding: DHS; Financial Aid; Self-pay; Other:
20a. If DHS was selected as a source of funding, what is your DHS counselor’s name?:
21. Harper College program involvement: Pathways; Distinguished Scholar; Promise; Other:
APPLICANT INFORMATION
Please answer the following questions:
1. Please list your specific learning differences and/or autism spectrum diagnosis:
2. Please list any medical conditions:
EDUCATIONAL INFORMATION
Please list all schools attended from 9th through 12th grades as well as any collegiate or other relevant
educational programs/experiences.
1. When did you begin high school?: 2. Graduation date:
3. Please enter your advisor/guidance counselor’s name:
4
4. What is your advisor/guidance counselor’s phone number?:
5. What is your advisor/guidance counselor’s email address?:
6. Please enter the name(s) of any former high school(s):
STUDENT STATEMENT
Please answer the following questions:
1. What are your best subjects in school?:
2. What are your most challenging subjects in school?:
3. Please describe your personal interests including hobbies and sports:
4. Please share why you should be considered for the TAP program?:
5
5. Please list three goals you would like to achieve while in TAP:
6. Please list your strengths:
7. Please list your challenges:
STUDENT STATEMENT RECEIPT
I agree that I will attend all required meetings and activities within the TAP Program.
Name:
Signature: Date:
6
FAMILY INFORMATION
Please provide information regarding immediate family members with whom the student resides with the
following questions:
Parent/Guardian #1
1. First name:
2. Last name:
3. Street address:
4. City, State, Zip:
5. Home phone:
6. Cell phone:
7. Work phone:
8. Email:
Parent/Guardian#2
1. First name:
2. Last name:
3. Street address:
4. City, State, Zip:
5. Home phone:
6. Cell phone:
7. Work phone:
8. Email:
9. Who will be the primary contact person (please select one person from above):
10. Additional Information:
7
PARENT STATEMENT
Please answer the following questions:
1. Please list three goals you would like your student to achieve while participating in TAP.
2. Please share any special considerations that TAP should be aware of in regards to the applicant.
3. How did you hear about TAP?
Please check all that apply:
Word of mouth
High School
Professional Referral
Advert
Other:
PARENT STATEMENT RECEIPT
I understand that by agreeing to have my student be a part of the TAP program, I also agree to attend two
meetings each semester, as well as family activities sponsored by TAP.
Name:
Signature: Date:
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1902TAP Application TAP Application

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Completed 19 May 2020

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