Fillable Highschool Rise Packet (Indian Hills Community College)

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Highschool Rise Packet (Indian Hills Community College)

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RISE is a secondary transitional
preparatory program for students on
a current Individualized Education
Program (IEP)
RISE
Raise Individual Student Expectations
www.indianhills.edu/rise
RISE
Raise Individual Student Expectations
RISE Referral Guidelines
PROGRAM DESCRIPTION
RISE is a 4+ program located at Indian Hills Community College. In conjunction with the student’s
high school, Indian Hills will continue to provide special education services to fulfill unmet transition
needs as identified in the student’s IEP.
CRITERIA FOR ENROLLMENT
• Enrolled in a high school special education program.
• Have unmet transition needs, as identified by the IEP team.
o Use the 4+ Transition Rubric for guidance.
• Between the ages of 16 and 21.
• Show desire and motivation to cooperate and communicate with RISE sta.
• Have met high school graduation requirements.
SUGGESTED CRITERIA FOR ENROLLMENT
• Socially responsible behavior.
• Maintains district attendance standard of 95% or better.
• No inappropriate contact with students or sta. Follows the student code of conduct.
• A minimum grade point average of 2.0 has been achieved or shows academic potential.
RISE/IHCC Packet Enclosures
RISE Referral Guidelines
RISE Referral Process for IEP teams
New Student Checklist
1
Contact
Madison Rushing, RISE Coordinator
800-726-2585, Ext. 1737
madison.rushing@indianhills.edu
Schedule a Visit Today!
www.indianhills.edu/rise
RISE
Raise Individual Student Expectations
RISE Referral Process
RISE Procedures for IEP Teams
Identification of a potential RISE candidate should take place, at a minimum, during the junior year. The
transition discussion should begin as early as age 14. Referral to the RISE program is a team decision and not
an individual recommendation.
Referral Procedures
1) The IEP team should complete a reevaluation during the student’s senior year to determine if the
student continues to be eligible for special education services or not. If not, the student is exited and
does not qualify for 4+ services. If the student does remain eligible, then the team should identify
the student’s needs, specifically those needs within the IEP, and discuss the placement options to
meet those needs.
2) It is suggested that the student visit the RISE program before a referral is made. Visit the IHCC
website to attend a College Transition Day. www.indianhills.edu/rise
3) If RISE is determined as a viable option;
a. Complete the RISE referral form and return to madison.rushing@indianhills.edu
b. Invite a RISE Representative to the IEP stang. This stang should take place the final
semester before attending RISE
c. Submit RISE packet by appropriate deadline.
IEP Procedures
1) Complete the RISE Transition Rubric. www.indianhills.edu/rise
a. Utilize the RISE Transition Rubric, as early as age 14, to help identify unmet transition needs.
2) Page “I” should include the following information;
a. Vocational Rehabilitation information
b. Accuplacer or ACT scores
c. Recent goals in IEP
d. Any health issues
e. Any behavior issues
f. Plans for living and/or transportation
g. Other information that may be relevant, but not included in their IEP.
3) Page B should include the following information;
a. Post-Secondary expectation for living, learning and working
All steps must be completed and submitted before a student referral will be accepted. Send all referral
information to Madison Rushing, RISE Coordinator, by the following deadlines.
• April 1 (Fall start)
• December 1 (Winter start)
Indian Hills Community College
Attn: Madison Rushing
525 Grandview Avenue
Ottumwa, IA 52501
Or
madison.rushing@indianhills.edu
For questions contact your AEA Consultant or call the RISE oce at 1-800-726-2585 ext. 5226
2
RISE
Raise Individual Student Expectations
RISE/IHCC Referral
(to be completed by a special education teacher)
Student Date
DISTRICT INFORMATION
High School
IEP Teacher Email
Name of District Administrator
Approving referral:
Date:
Is the student open enrolled from another school district? yes no
If yes, which district?
If yes, name of district Administrator
Approving Referral:
Date:
ATTENDANCE & ACADEMIC HISTORY
Total Absences:
Senior Year (as of ) Junior Year Sophomore Year
Current Cumulative GPA:  
Explanation of Excessive Absences or Tardiness:
VOCATIONAL REHABILITATION
Does the student have a file with Vocational Rehabilitation? yes no
IEP INFORMATION
Reevaluation Date: Consultant:
Areas of Academic Need:
Math
   Reading Comprehension    Written Expression    Other (explain below)   
Transition Needs:
Accommodations: Please list all accommodations student is currently using:
(Continued on next page)
3
RISE
Raise Individual Student Expectations
(IEP Information continued)
Student Transportation:
The sponsoring district will provide transportation in the following manner:
School Bus or Van
City Bus Pass
Mileage Reimbursement
IHCC Housing
Other
The sponsoring district will provide a laptop computer: Yes No
Assistive Technology (specify):
REFERRAL APPROVAL
I certify that my answers are true and complete to the best of my knowledge
Teacher Signature:
Date:
Administration Signature: Date:
APPLICATION DEADLINE
RISE applications must be received prior to the appropriate deadline listed on page three.
Return to:
Indian Hills Community College
Madison Rushing
525 Grandview Ave
Ottumwa, Iowa 52501
It is the policy of Indian Hills Community College not to discriminate on the basis of race, color, national origin, sex, disability, age (employment),
sexual orientation, gender identity, creed, religion, and actual or potential parental, family, or marital status in its programs, activities, or
employment practices as required by the Iowa Code §§216.6 and 216.9, Titles VI and VII of the Civil Rights Act of 1964 (42 U.S.C. §§ 2000d
and 2000e), the Equal Pay Act of 1973 (29 U.S.C. § 206, et seq.), Title IX (Educational Amendments, 20 U.S.C §§ 1681 – 1688), Section 504
(Rehabilitation Act of 1973, 29 U.S.C. § 794), and Title II of the Americans with Disabilities Act (42 U.S.C. § 12101, et seq.).
If you have questions or complaints related to compliance with this policy, please contact Director, Human Resources/Equity Coordinator (sta),
525 Grandview Ave, Ottumwa, IA 52501, 683-5108, hrequity@indianhills.edu; Dean, Student Aairs (students), 683-5159, studentsequity@
indianhills.edu; Dean, Learning Services (students with disabilities), 683-5174, learningservicesequity@indianhills.edu; U.S. Department of
Education, Citigroup Center, 500 W. Madison, Suite 1475, Chicago, IL 60661, phone number 312/730-1560, fax 312/730- 1576.
4
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RISE
Raise Individual Student Expectations
New Student Checklist
(to be completed by the student)
The following information/steps should be completed by the prospective student.
Student Profile
Complete the college entrance exam
 The exam is available on the Ottumwa Campus, Centerville Campus, or any of the IHCC
service centers.
 A photo ID and social security number are required to take the exam. Call (641) 683-5142 for
more information.
Send high school transcripts to IHCC — Indian Hills Community College
ATTN: Registrar
525 Grandview Ave.
Ottumwa, IA 52501
 Complete all IHCC program entry requirements. See specific IHCC program information for details.
Students will not be accepted into an IHCC program until all requirements are met.
 Review and sign the RISE Attendance Policy.
 Review and sign the RISE IHCC Student Conduct.
 Review and sign the Student Disability Services Release of Confidential Information.
 Complete IHCC Application form (must be completed paper copy, not online)
 If already completed online, make notation here.
 After acceptance, students will receive a detailed letter with information on class registration and
orientations.
Note: If a student is unable to attend IHCC/RISE, he/she must notify IHCC, RISE, and his/her high school.
Additional Information: Students in the RISE program do not qualify for financial aid and should not
complete the FAFSA. RISE students are still considered high school students and their diploma will be
held by the district until the student has exited from special education services.
5
It is the responsibility of the student to contact IHCC and RISE if their phone number, mailing
address, and or email address changes any time after application materials have been
submitted. Contact RISE at 800.726.2585, ext. 5226, for additional information.
RISE
Raise Individual Student Expectations
Student Profile
Program of Study:
Student
Name:
Address:
City, State, Zip:
Phone: (home)  (cell)
Date of Birth:  SSN#
Email:
Parent / Guardian
Name: Relationship:
Address:
City, State, Zip:
Phone: (home)  (cell)
Email:
Parent / Guardian
Name: Relationship:
Address:
City, State, Zip:
Phone: (home)  (cell)
Email:
Special Needs / Concerns
6
RISE
Raise Individual Student Expectations
RISE Attendance Policy
• A total of three absences will be accepted during any given term (12-week period). Upon the fourth
absence, an IEP meeting will be held to decide what action will be taken.
• Tardiness will not be tolerated. Three individual tardies will count as one missed class. Three
individually missed classes will result in a day’s absence.
• RISE students follow the IHCC scheduling, including weather delays or cancellations. If a student’s
family feels it is unsafe for him/her to travel, the student must notify all of the teachers of classes that
will be missed. The student is responsible to make up all missed work.
• RISE is a closed campus program. The student’s family assumes all responsibility and liability when
the student is not in educational programming and if the student leaves the campus.
I HAVE READ AND UNDERSTAND THE ABOVE POLICY.
Student Signature Date
Parent Signature Date 
7
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RISE
Raise Individual Student Expectations
RISE/IHCC Student Code of Conduct
Indian Hills Community College is an academic community built on the principles of mutual respect, integrity,
and honesty. The college strives to provide a community wherein individuals have the right to express their
opinions and ideas, to assemble peacefully, and to associate freely in a manner that does not interfere
with the rights of others and is in the confines of intellectual honesty. In order to thrive as an educational
institution, the college has adopted this Student Conduct Code (“Student Code”) to promote and preserve
its educational mission for the benefit of all who are invited to be a part of the community.
Please read the Student Conduct Code at www.indianhills.edu/studentconduct
The IEP team reserves the right to exit the student from special education services and the RISE program, if
deemed appropriate, due to misconduct and/or failing to maintain attendance and/or educational standards.
I HAVE READ AND UNDERSTAND THE ABOVE POLICY.
Student Signature Date
Parent Signature Date 
8
RISE
Raise Individual Student Expectations
Release of Confidential Information Form 2017
IHCC SDS FORM 2
INDIAN HILLS COMMUNITY COLLEGE
Student Disability Services
Release of Confidential Information
Student’s Name: _______________________________________________
IHCC ID # ________________________________ Birthdate: __________
Permission for IHCC Instructors/Professors & Appropriate Staff
I hereby give permission to the IHCC Student Disability Services Coordinators to
release confidential information from my file in order to set up classroom
accommodations and/or services connected to accessibility and my specific
disability. I understand that I must provide the required documentation of my
disability in order to receive accommodations and services.
________________________________
__________ ________________
(Student’s Signature) (Date)
Permission for Family, Agencies, and Others
I hereby give permission to the IHCC Student Disability Services Coordinators to
release confidential information on my behalf to the following:
☐Parents/Guardians: __________________________________________
☐Vocational Rehabilitation Counselor: _____________________________
☐Job Corps: _________________________________________________
☐Other: _____________________________________________________
I understand that this authorization is in effect until I complete an updated form.
__________________________________________ ________________
(Student’s Signature) (Date)
COMPLETED FORMS MAY BE FAXED TO (641) 68
3-5206
ATTN: IHCC Disability Services Office
9
RISE
Raise Individual Student Expectations
Application for Admission
PERSONAL DATA
Legal Name
__________________________________________________________________________________________________________ ________
Last First Middle Maiden Former
*Social Security Number
_________ - ______- ________________
Mailing Address
_________________________________________________________________________________________________________ ____
House No Street Box Apt No
___________________________________________________________________________________ __________________________
City State Zip County
Primary Phone
(____) _____-__________
Accepts Texts
Email Address
____________________________________________
Secondary Phone
(____) _____-__________
Accepts Texts
Birth Date
(
mm/dd/yyyy
) ______/_____/_______
Gender
: Male Female
Ethnic Background:
Are you Hispanic or Latino?
Yes No
Select one or more races:
.
Will you be receiving assistance from the Veterans Administration
Yes No
I am required to register as a sex oender
Yes No
ACADEMIC INFORMATION
Start Term (check one only
) FALL WINTER SPRING SUMMER
Start Year
__________
Program of Study
______________________________________ Ottumwa Centerville
***All programs and start terms oered are listed on back of application
Admit Status
After leaving IHCC, do you plan to:
1. Prepare to enter the job market 5. Transfer to another college/university
2. Improve skills for present job 6. Explore courses to decide on a career
3. Prepare to change careers 7. Self Improvement/Improve basic skills
4. Meet certication/licensure requirements 8. Personal Interest
(other than for initial job entry) 9. Undecided/Unknown
Educational Goals
(check one only
)
Degree Seeking (plan to pursue a degree or diploma) Non Degree Seeking (do not plan to pursue a degree or diploma)
RESIDENCY INFORMATION
How long have you resided Iowa?
1. I don’t live in Iowa 3. I was born in Iowa
2. Less than 90 days 4. More than 90 days
What brought you to Iowa?
1. I came to Iowa to attend college 3. I don’t live in Iowa
2. I was born in Iowa 4. I relocated for family or work
Are you a U.S. Citizen?
Yes
No
If you are not a U.S. citizen, are you a permanent resident of the U.S.?
Yes
No
For information on campus housing, please contact the housing oce at (641) 683-5152 or (800) 726-2585, extension 5152.
(IRS regulations require Indian Hills Community College to request a SSN as a Taxpayer ID number for use in tax reporting. Any student applying
for Financial Aid (grants and loans) must provide a social security number to Indian Hills Community College.)
(
AM)
Amer Indian/Alaskan Native
(
AS)
Asian
(
BL)
Black/African American
(
HP)
Native Hawaiian/or other Pacic Islander
(WH)
White
(not Hispanic)
10
RISE
Raise Individual Student Expectations
EDUCATION INFORMATION
All transcripts submitted become the property of IHCC and cannot be returned or sent to another institution.
Please submit a copy of your high school transcript or High School Equivalency Diploma to the Admissions Oce.
Please submit all college transcript(s) to the Registrar’s Oce.
High School Attended ___________________________________ City __________________ State _______
Currently in High School - Anticipation Graduation: (month) __________ (year) ______
Have you attended another college other than Indian Hills? Yes No If yes, how many _______
FAMILY BACKGROUND DATA
Did either of your parents (or guardians) receive a four-year college degree? Yes No
If yes, select all that apply: Father Mother Guardian
CERTIFICATION
I certify that all information contained in this application is factually correct and complete. I understand
that it is my responsibility to request ocial transcripts be sent to Indian Hills Community College from
each academic institution I have attended. I also understand that the misrepresentation or omission of
application information is sucient grounds for canceling my admission or registration.
Signature of Applicant ____________________________________________ Date _________________
COLLEGE ADDRESSES
Oce of Admission, Indian Hills Community College, 525 Grandview Avenue, Ottumwa, IA 52501.
Phone: (641) 683-5153 or (800) 726-2585, ext. 5153. No Application Fee
Oce of Admission, Indian Hills Community College, 721 North First St., Centerville, IA 52544.
Phone: (641) 856-2143 or (800) 670-3641, ext. 2225. No Application Fee
11
RISE
Raise Individual Student Expectations
F = Fall  W= Winter  SP = Spring  SU = Summer   A = All
IHCC Credit Program Oerings
ARTS & SCIENCES DIVISION
Program Loc. Term Mo. Degree
Arts & Sciences Cen All 18 AA
Arts & Sciences Ott All 18 AA
Arts & Sciences Graduate Ott All
Arts & Sciences in Agriculture Education Cen All 18 AA
Arts & Sciences in Agronomy Cen All 18 AS
Arts & Sciences in Animal Science Cen All 18 AS
Arts & Sciences in Biology Ott All 18 AS
Arts & Sciences in Business Cen All 18 AA
Arts & Sciences in Business Ott All 18 AA
Arts & Sciences in Chemistry Cen All 18 AS
Arts & Sciences in Chemistry Ott All 18 AS
Arts & Sciences in Communications Cen All 18 AA
Arts & Sciences in Communications Ott All 18 AA
*Arts & Sciences in Criminal Justice Ott All 18 AA
*Arts & Sciences in Early Childhood Teaching Cen All 18 AA
*Arts & Sciences in Early Childhood Teaching Ott All 18 AA
*Arts & Sciences in Elementary Education Cen All 18 AA
*Arts & Sciences in Elementary Education Ott All 18 AA
Arts & Sciences in Fine Arts Cen All 18 AA
Arts & Sciences in Fine Arts Ott All 18 AA
Arts & Sciences in Mathematics Ott All 18 AS
Arts & Sciences in Physics Ott All 18 AS
Arts & Sciences in Psychology Ott All 18 AA
*Arts & Sciences in Secondary Education Cen All 18 AA
*Arts & Sciences in Secondary Education Ott All 18 AA
Arts & Sciences in Sociology Cen All 18 AA
Arts & Sciences in Sociology Ott All 18 AA
Arts & Sciences in Theater Ott All 18 AA
Arts & Sciences – Online Online All 18 AA
Arts& Sciences – Pre-Health Cen All
Arts& Sciences – Pre-Health Ott All
*Criminal Justice Ott F/Sp/Su 21 AAS
Culinary Arts Ott F 21 AAS
ESL Ott F/W/Sp
Guest Student Ott All
Hotel & Restaurant Management Ott F 21 AAS
*Screened program - students will need to pass a background check prior to acceptance
Updated 3/20
ADVANCED TECHNOLOGY DIVISION
Agriculture/Grounds Loc Term Mo. Degree
Animal Science Cen All 21 AAS
Landscape & Turfgrass Technology Cen All 21 AAS
Precision Farming Cen All 21 AAS
Information Technology
Accounting Assistant Ott All 12 Dip
Business Specialist – (Centerville) Cen All 9 Dip
Business Specialist Ott All 9 Dip
Business Specialist – Accounting Ott All 18 AAS
Business Specialist – Oce Mgt Ott All 18 AAS
Computer Accounting Ott All 6 Dip
Computer Software Development Ott All 21 AAS
Cybersecurity and Systems Administration Ott F/Sp 21 AAS
Geospatial Technology Ott F/Su 18 AAS
Interactive Media Technology Ott F/Su 21 AAS
Manufacturing
Agricultural/Biofuels Process Technology Ott/Eddyv F 21 AAS
Bio-Manufacturing Ott/Eddyv F 9 Dip
Construction Technology Cen All 24 AAS
Electrical & Renewable Energy Ott F 24 AAS
Electronic Engineering Technology Ott F/Sp 21 AAS
HVAC and Refrigeration Ott F/Sp 6 Dip
Industrial Maintenance Ott F/Sp 18 AAS
Industrial Maintenance Technician Ott F/Sp 9 Dip
Laser & Optics Technology Ott F/Sp 21 AAS
Machine Technology Ott All 18 AAS
Process Control Ott F 9 Dip
Robotics/Automation Technology Ott F/Sp 21 AAS
Welding Technology Ott F/Sp 18 AAS
Welding Technology Ott F/Sp 12 Dip
Transportation
Automotive Technology Ott F/Sp 21 AAS
Aviation Maintenance Technology Ott F 21 AAS
Avionics Electronic Technician Ott Su 9 Dip
Diesel Technology Ott F/Sp 21 AAS
Updated 7/19
12
RISE
Raise Individual Student Expectations
13
HEALTH SCIENCES DIVISION
Program Loc. Term Mo. Degree
Arts & Sciences – Pre-Health Ott
Arts & Sciences – Pre-Health Cen
Child Care Technician Ott F/W 12 Dip
Clinical Laboratory Assistant Ott F 9 Dip
Dental Assisting Ott F 12 Dip
Dental Hygiene Ott F 24 AAS
Early Childhood Associate Ott F/W 21 AAS
Health Information Technology Online F/Sp 21 AAS
Health Unit Coordinator Online F 6 Dip
Medical/Insurance Coding Online F/Sp 12 Dip
Medical Laboratory Technology Ott Su 24 AAS
Medical Scribe Online F/Sp 12 Dip
Nursing – Associate (Day – 2nd year) Ott W/Su 12 AAS
Nursing – Associate (Day – 2nd year) Cen Su 12 AAS
Nursing – Associate (Day – both years) Ott W/Su 24 AAS
**Nursing – Associate (Hybrid – 2nd year) Online/Ott W 21 AAS
Nursing – Practical (Day – 1st year) Ott W/Su 12 Dip
Nursing – Practical (Day – 1st year) Cent Su 12 Dip
Nutrition & Dietary Management Ott F 18 AAS
Occupational Therapy Assistant Ott F 21 AAS
Paramedic Ott F/Sp 24 AAS
Paramedic Core Ott W/Su 21 Dip
Physical Therapist Assistant Ott F 21 AAS
Radiologic Technology Ott F 24 AAS
Surgical Tech (Co-op w/Kirkwood CC) Ott F 12 Dip
CERTIFICATE PROGRAMS
(not eligible for Title IV Funding)
Advanced Emergency Medical Tech Ott F 6 Cert
Emergency Medical Responder (Eve) Ott W 3 Cert
Emergency Medical Technician Cen F/Sp 6 Cert
Emergency Medical Technician Ott F/Sp 6 Cert
Phlebotomy Technician Ott W 6 Cert
**Temporarily not available
Updated 2/20
IHCC Credit Program Oerings
F = Fall  W= Winter  SP = Spring  SU = Summer   A = All
RISE
Raise Individual Student Expectations
Madison Rushing
Coordinator, RISE Program
525 Grandview Ave
Ottumwa, IA 52501
800-726-2585, ext. 1737
RISE Classroom (641) 683-5226
madison.rushing@indianhills.edu
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