Fillable Tapapplication2016 - TAP Application

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Tapapplication2016 - TAP Application

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Than
you for applying to Project TAP.
k
The goals of Project TAP are
To create a multilayered approach to bolster success in
academics, improve interpersonal relationships, and ultimate
credential completion at Harper.
Direct alignment with college initiatives to improve on-boarding
and retention of students in their first year of studies.
Direct alignment with departmental priorities to continue improving
services for students on the Autism Spectrum.
An application to the TAP program is considered complete and will
only be accepted if it includes:
Completed and Accepted into Harper College for Fall 2016
An Intake on file with the Access and Disabilities Office
A Psychological evaluation showing an Autism Spectrum diagnosis
or the most recent IEP or 504 plan with autism diagnosis
ACT scores or Compass Placement Scores
Transcript from High School; must have 2.75 out of 4.0 GPA
Parent Supplement
Answered essay question
Once you submit your application, you will receive confirmation of
receipt from Project TAP. Further confirmation will be sent as
supporting materials are received. Once your application is
complete, it will be reviewed and an invitation extended to you to
interview if it is felt our program is a good match. An in-person
interview is required.
Please mail all application requirements to
Project TAP/Access and Disability Services
Harper College
1200 W. Algonquin Road
Palatine, IL 60067-7398
Or fax to 847.925.6267, Attention: Project TAP
If you have questions or need assistance, please call 847.925.6266
during our normal business hours: Monday through Thursday, 8 am
until 7 pm; Fridays, 8 am until 4:30 pm.
Project TAP Applicant Information
Today’s date: Status: Student Parent Education Professional
First Name
Last Name:
Email
@
Street Address:
City: ST: IL Other: ZIP
Home Phone  Cell Phone
Gender:
Male
Female Primary Language:
English Other
Date of Birth: Age:
Feeder School:
Barrington
Buffalo Grove
Christian Liberty
Conant
D211
D214
Elk Grove
Fremd
Hersey
Hoffman Estates
Home School
Palatine
Prospect
Rolling Meadows
Schaumburg
Schaumburg Christian
St. Viator
Wheeling
Other
GPA:
Application Complete: for Harper - Date
Intake Complete Yes No Essay Complete
Yes
No
Funding Sources: DHS Fin Aid
Concurrent with another program: Pathways Distinguished Scholar?
Other
APPLICANT INFORMATION
Please answer all questions
LIST YOUR SPECIFIC LEARNING DIFFERENCES AND/OR AUTISM SPECTRUM DISORDERS:
LIST ANY MEDICAL CONDITIONS:
EDUCATIONAL INFORMATION
Please list all schools attended from 9
th
through 12
th
grades.
Also include colleges or other relevant educational programs.
CURRENT SCHOOL OR PROGRAM
NAME CURRENT GRADE
ADDRESS START DATE
CITY, STATE, ZIP END DATE
MAIN PHONE
ADVISOR/GUIDANCE COUNSELOR AT CURRENT SCHOOL
NAME CURRENT GRADE
ADDRESS START DATE
CITY, STATE, ZIP END DATE
MAIN PHONE
PREVIOUS SCHOOL OR PROGRAM
NAME CURRENT GRADE
ADDRESS START DATE
CITY, STATE, ZIP END DATE
MAIN PHONE
STUDENT STATEMENT
Please answer all questions.
1. WHAT ARE YOUR BEST SUBJECTS AT SCHOOL?
2. WHAT ARE YOUR MOST CHALLENGING SUBJECTS AT SCHOOL?
3. DESCRIBE YOUR PERSONAL INTERESTS, INCLUDING HOBBIES AND SPORTS
4. WHY SHOULD YOU BE CONSIDERED FOR PROJECT TAP?
5. WHY WOULD YOU LIKE TO BE IN PROJECT TAP?
6. LIST GHREE GOALS YOU WOULD LIKE TO ACHIEVE WHILE IN TAP:
A)
B)
C)
7. LIST YOUR STRENGTHS:
8. LIST YOUR CHALLENGES:
I agree by signing up for Project TAP I will attend all required meetings and activities or I may be
asked to leave the program?
Signature Date
FAMILY INFORMATION
Family with whom the student resides.
Parent/Guardian #1
FIRST NAME
LAST NAME
HOME MAILING
ADDRESS
CITY, STATE, ZIP
HOME PHONE
CELL PHONE
WORK PHONE
EMAIL ADDRESS
PARENT/GUARDIAN
OCCUPATION
Parent/Guardian #2
FIRST NAME
LAST NAME
HOME MAILING
ADDRESS
CITY, STATE, ZIP
HOME PHONE
CELL PHONE
WORK PHONE
EMAIL ADDRESS
PARENT/GUARDIAN
OCCUPATION
PRIMARY CONTACT PERSON (FROM ABOVE)
Notes:
PARENT STATEMENT
Please answer all questions.
1. LIST THREE GOALS YOU WOULD LIKE YOUR STUDENT TO ACHIEVE WHILE PARTICIPATING
PROJECT TAP:
1)
2)
3)
2. PLEASE EXPLAIN ANY SPECIAL CONSIDERATIONS THAT TAP SHOULD BE AWARE OF IN
REGARD TO YOUR STUDENT:
I Understand that by agreeing to have my son/or daughter be a part of project TAP, I also
agree to attend two meetings throughout the semester as well as any family activities
sponsored by TAP.
Signature Date
HOW DID YOU HEAR ABOUT PROJECT TAP?
Check all that apply.
☐WORD OF MOUTH ☐HIGH SCHOOL
☐PROFESSIONAL REFERRAL ☐ADVERTISEMENT
OTHER / PLEASE EXPLAIN:
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Completed 9 February 2020

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