Fillable Dear PAVE Applicant; Thank you for your interest (J Sargeant Reynolds Community College)

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Dear PAVE Applicant; Thank you for your interest (J Sargeant Reynolds Community College)

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Dear PAVE Applicant;
Thank you for your interest in the Program for Adults in Vocational Education (PAVE) at
Reynolds Community College. Enclosed you will find our Application packet including the
following materials:
1. PAVE Application
2. Release and Exchange of Information Form- HIGH SCHOOL and Release and Exchange of
Information- DARS OR OTHER SUPPORTING AGENCY
3. Reference Form 1 and Reference Form 2
In addition we also need the following items:
-Individualized Education Plan (IEP)
-Official Sealed Copy of High School Transcript AND Letter on school letterhead verifying your
name, date of birth, type of diploma, and graduation date (submitted after high school graduation)
-Psychological Assessment or Evaluation, preferably from within the past 4 years
Vocational Evaluation
-Students should also complete the Free Application for Federal Student Aid (FAFSA) at
http://www.fafsa.ed.gov/ as soon as possible.
In order for to be considered for admission to the Fall cohort for PAVE, your completed PAVE
application packets and all required paperwork must be received no later than June 30th.
Again, we thank you for your interest in PAVE. If you have any questions, please feel free to
contact our office at (804) 523-5572 or visit our website:
http://www.reynolds.edu/student_services/pave/default.aspx
Sincerely,
PAVE at Reynolds Community College
APPLICATION FOR ADMISSION
PAVE Program
Reynolds Community College
Phone (804) 523-5572 Fax (804) 786-4955
pave@reynolds.edu
http://www.reynolds.edu/student_services/pave/default.aspx
NAME_______________________________________________________________
First Middle Initial Last
ADDRESS____________________________________CITY____________________________
STATE_______ ZIP________________________
HOME PHONE____________________ CELL PHONE______________________________
EMAIL______________________________________________________________________
DATE OF BIRTH________________________ Sex (select one) MALE FEMALE
HIGH SCHOOL__________________________________ GRADUATION DATE _________
Month Year
DISABILITY__________________________________________________________________
Diploma Type (select one) Standard Modified Standard Special Other___________
Official letter from high school verifying diploma status is required with application
Which program would you like to study? (select one)
CHILD CARE CLERICAL FOOD SERVICE PERSONAL CARE
Have you attended the PAVE Program before? YES NO
If yes, when? ___________________________________________________________
Do you currently have a Department for Aging and Rehabilitative Services (DARS) Counselor?
YES NO
If yes, list name and phone number__________________________________________
Are you currently employed? YES NO
If yes, where? ______________________________________________________________
Have you completed the Virginia Community College Application for Admission?
YES NO
Have you filled out the Free Application for Federal Student Aid (FAFSA)? YES NO
FOR OFFICE USE ONLY- STUDENT EMPL ID
Authorization for Exchange and Release of Information
Reynolds Community College PAVE Program
Phone (804) 523-5572 Fax (804) 786-4955
Date: ___________________
From: _________________________________________________________________ (Student name)
To: _________________________________________________________________ (High School)
Subject: Verification and Documentation of Disability
Student Address:
_________________________
_________________________
Date of Birth
_________________________
Year of Graduation
_________________________
I authorize the above-named counselor to release documentation checked off on the list below to
Reynolds Community College. I also authorize the PAVE Program to share pertinent
information with agencies and/or persons with a legitimate educational need to know such
information.
Student Signature_____________________________________Date:__________________
Please send the requested information to:
Reynolds Community College
PAVE Program
P.O. Box 85622
Richmond, VA 23285-5622
PAVE OFFICE USE ONLY
__ Psychological Assessments __ Transition Plan
__ Vocational Assessments
__ Other
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Authorization for Exchange and Release of Information
Reynolds Community College PAVE Program
Phone (804) 523-5572 Fax (804) 786-4955
Date: ___________________
From: _________________________________________________________________ (Student name)
To: _________________________________________________________________ (High School)
Subject: Verification and Documentation of Disability
Student Address:
_________________________
_________________________
Date of Birth
_________________________
Year of Graduation
_________________________
I authorize the above-named counselor to release documentation checked off on the list below to
Reynolds Community College. I also authorize the PAVE Program to share pertinent
information with agencies and/or persons with a legitimate educational need to know such
information.
Student Signature_____________________________________Date:__________________
Please send the requested information to:
Reynolds Community College
PAVE Program
P.O. Box 85622
Richmond, VA 23285-5622
PAVE OFFICE USE ONLY
__ Psychological Assessments __ Transition Plan
__ Vocational Assessments
__ Other
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Reference Form
Reynolds Community College
Program for Adults in Vocational Education
Phone (804) 523-5572 Fax (804) 786-4955
To be completed by applicant:
Applicant Name_______________________________________________________________________
Date of Birth__________________________________________________________________________
Program to which student is applying (circle one): Clerical Child Care Food Service Personal Care
The Education Rights and Privacy Act of 1974 and its amendments guarantee students access to their educational records.
Students, however, are entitled to waive their right of access concerning references. The following statement is the applicant’s
wish regarding this reference.
__ I waive my right to inspect the contents of this reference ___ I do NOT waive my right to inspect this reference
Student’s Signature__________________________________ Date: _________________________________________
To be completed by recommender:
Reference’s Name___________________________________________________________________________________
Telephone: _______________________________________ Email: ___________________________________________
How long have you known the Applicant? ____________ Organization: _______________________________________
May we contact you regarding this applicant? ___YES ___ NO
Relationship to Student: ____________________________________________________________________________
How would you assess the student in the following areas with regard to their intended program of study?
Superior
Above Average
Average
Poor
Unknown
Study Skills
Social Skills
Motivation
Cooperation
Attitude
Reliability
Attendance
Please provide your opinion of the applicant’s ability to succeed in a college environment. Attach an additional sheet if needed:
Please forward this reference directly to:
Reynolds Community College
PAVE
P. O. Box 85622
Richmond, VA 23285-5622
Signature: __________________________________ Date: ________________________
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Reference Form
Reynolds Community College
Program for Adults in Vocational Education
Phone (804) 523-5572 Fax (804) 786-4955
To be completed by applicant:
Applicant Name_______________________________________________________________________
Date of Birth__________________________________________________________________________
Program to which student is applying (circle one): Clerical Child Care Food Service Personal Care
The Education Rights and Privacy Act of 1974 and its amendments guarantee students access to their educational records.
Students, however, are entitled to waive their right of access concerning references. The following statement is the applicant’s
wish regarding this reference.
__ I waive my right to inspect the contents of this reference ___ I do NOT waive my right to inspect this reference
Student’s Signature__________________________________ Date: _________________________________________
To be completed by recommender:
Reference’s Name___________________________________________________________________________________
Telephone: _______________________________________ Email: ___________________________________________
How long have you known the Applicant? ____________ Organization: _______________________________________
May we contact you regarding this applicant? ___YES ___ NO
Relationship to Student: ____________________________________________________________________________
How would you assess the student in the following areas with regard to their intended program of study?
Superior
Above Average
Average
Poor
Unknown
Study Skills
Social Skills
Motivation
Cooperation
Attitude
Reliability
Attendance
Please provide your opinion of the applicant’s ability to succeed in a college environment. Attach an additional sheet if needed:
Please forward this reference directly to:
Reynolds Community College
PAVE
P. O. Box 85622
Richmond, VA 23285-5622
Signature: __________________________________ Date: ________________________
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Dear PAVE Applicant; Thank you for your interest (J Sargeant Reynolds Community College)

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Completed 27 July 2020

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