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Have you been diagnosed with a learning disability, AD/HD, or ASD? ____ Yes ____ No
If yes, what is the diagnosis? If no, what is your documented disability? _____________________
Do you/did you have an Individualized Education Plan (IEP) or 504 in high school? ___ Yes ___ No
Have you ever attended college? ____ Yes ____ No If yes, where/when?_____________________
Did you receive accommodative services? If yes, what were they ___Yes ___ No
What academic courses do you find most difficult? ________________________________________
What aspect of school challenges you the most?
___ Note taking ___ Test taking ___ Staying Organized
___ Studying ___ Focusing ___ Time management
___ Reading ___ Socializing/Communicating Other ____________________
What skills and strategies do you hope to develop by participating in MVCC’s Transition Day?
Who or what led you to apply to MVCC’s PREP program?
____ It was mailed ___ ACCES-VR ___ Guidance Counselor ___ MVCC Staff/Faculty ___ Other
____ Resource room teacher ____ MVCC Website
Please list any special accommodations (including food allergies) you may require:
The PREP program offers a 1 hour information session from 3-4pm when advocates can learn about
ACCES-VR and ask individualized questions. The session also offers a time to meet Accessibility staff and learn
about disability-related services and accommodations at the college level.
Are you interested in attending this session on the date your student attends the PREP program?
___ Yes ___ No
My signature below indicates that the information in my application is correct, inclusive, and honestly
Signature of Applicant ___________________________________________ Date _______________
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