Application

Ready to get started? Please complete our online application, and our admissions team will contact you with additional information.

Step 1 of 9 - Student Information

Family Information
Parent/Guardian #1
First Middle Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Cell Phone
Home Phone
Work Phone
Email
Parent/Guardian #2
First Middle Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Cell Phone
Home Phone
Work Phone
Email

Student Medical Information
Medical 1: Please list and describe all of your medical diagnoses, including those related to physical and mental health, that are currently applicable.
Please list and describe all of your medical diagnoses, including those related to physical and mental health, that are currently applicable.
Medical 2: Are there any medical or physical reasons why you may not be able to participate in activities on or off campus?
Are there any medical or physical reasons why you may not be able to participate in activities on or off campus? If yes, please explain in detail.
Medical 3: Please list all medications that you are currently taking and the reason for the prescription.
Please list all medications that you are currently taking and the reason for the prescription.
Medical 4: In the past 1-4 years, have you received any form of therapy (e.g. behavior therapy, occupational therapy, physical therapy, counseling or services from a psychologist)?
In the past 1-4 years, have you received any form of therapy (e.g. behavior therapy, occupational therapy, physical therapy, counseling or services from a psychologist)? If yes, please describe the service, reason, and result.
Medical 5: Are you able to take your medication independently or with the support of prompting provided by technology?
Are you able to take your medication independently or with the support of prompting provided by technology? If no, please explain.
Medical 6: Do you require any specialized supports that are medical in nature?
Do you require any specialized supports that are medical in nature? If yes, please explain.
Medical 7: Do you have any food allergies or special diets that require attention daily?
Do you have any food allergies or special diets that require attention daily? If yes, please explain and note whether or not you are able to monitor independently.
Note: AbleLight College does not have the staffing abilities to provide medical supports for students that require highly specialized care needs.

Student Educational Information
Post-Secondary Program
School Name City/State Start Attendance End Attendance
High School
School Name City/State Start Attendance End Attendance
Middle School
School Name City/State Start Attendance End Attendance
Elementary School
School Name City/State Start Attendance End Attendance
Education 1: Have you received special education services while in school?
Have you received special education services while in school? If yes, at what grade did you start those services?
Education 2: What is your primary disability?
What is your primary disability? Please list any secondary or additional diagnoses.
Education 3: What type of programming did you receive in school?
What type of programming did you receive in school? (e.g. self-contained, specialized school, resource room, general education with in class supports, etc.)
Education 4: Did you have any disciplinary events during the last three years of school that resulted in specialized behavior plan, suspension, expulsion or removal to an alternative placement?
Did you have any disciplinary events during the last three years of school that resulted in specialized behavior plan, suspension, expulsion or removal to an alternative placement? If yes, please explain.

Student Employment History
Paid Work Experience
List most recent first.
Employer Job Title Start Employment End Employment Responsibilities Wages Reason for Leaving
Volunteer Work Experience
List most recent first.
Employer Job Title Start Employment End Employment Responsibilities Reason for Leaving
Employment 1: Are you connected with DVR?
Are you connected with DVR? If yes, what county did you receive services in and who is your counselor (please add in counselor’s contact information)

Student Funding Information
Have you applied for SSI benefits?*
- Yes
- No
Do you currently have a case manager through Medicaid waiver funding? (person who helps with long-term care funding)*
- Yes
- No
Are you using family care or IRIS?*
- Yes
- No
Funding 1: Please list below any additional information or contact information you have with different governmental agencies you have been connected with.
Please list below any additional information or contact information you have with different governmental agencies you have been connected with.
Note: Various funding sources may help in funding your college experience. Please ask an AbleLight College professional staff member for more information.

Personal Information for Interview Questions
Please answer the following questions to the best of your ability to help our staff get to know you better. If it works best, you can have someone write the answers for you. However, we would like the answers to be in your own words.
Interview 1: How do you get along with other members of your family?
How do you get along with other members of your family?
Interview 2: What was your favorite class in high school?
What was your favorite class in high school?
Interview 3: Who was your favorite teacher?
Who was your favorite teacher? Why?
Interview 4: What are your favorite things to do when you are not in school or at work?
What are your favorite things to do when you are not in school or at work?
Interview 5: Do you enjoy hanging out with friends?
Do you enjoy hanging out with friends?
Interview 6: Who are some of your friends and what type of activities do you like to do with them?
Who are some of your friends and what type of activities do you like to do with them?
Interview 7: What are some of your strengths?
What are some of your strengths?
Interview 8: What are some of your weaknesses/
What are some of your weaknesses/ barriers?
Interview 9: What helps you accommodate for those weaknesses/barriers?
What helps you accommodate for those weaknesses/ barriers?
Interview 10: Do you like using technology?
Do you like using technology?
Interview 11: Do you have a favorite TV show, movie, music, or favorite of all three? Can you share those with us?
Do you have a favorite TV show, movie, music, or favorite of all three? Can you share those with us?
Interview 12: What is your favorite food and drink?
What is your favorite food and drink?
Interview 13: Do you like sports?
Do you like sports? If yes, what is your favorite sport and who is your favorite team?
Interview 14: How do you deal with stress?
How do you deal with stress?
Interview 15: What helps you relax when you are stressed?
What helps you relax when you are stressed?
Interview 16: Do you take care of your own money (e.g. debit card, bank accounts, cash)? Who assists you with money management?
Do you take care of your own money (e.g. debit card, bank accounts, cash)? Who assists you with money management?
Interview 17: What type of chores do you have at home? (e.g. taking care of your room, dishes, laundry, cleaning, etc.)
What type of chores do you have at home? (e.g. taking care of your room, dishes, laundry, cleaning, etc.)
Below, please write about what you would like to learn in each of these areas and what might be difficult for you.
Learn 1: Independent Living
Independent Living
Learn 2: Employment
Employment
Learn 3: Financial Literacy/Money Management
Financial Literacy/Money Management
Learn 4: Academics
Academics
Learn 5: Social
Social
Learn 6: Health and Wellness
Health and Wellness
Learn 7: Other
Other

Transition Plans
Transition 1: Why do you want to go to college?
Why do you want to go to college?
Transition 2: Why did you decide to apply to AbleLight College?
Why did you decide to apply to AbleLight College?
Transition 3: Where do you want to live when you finish college? (e.g. at home, in an apartment, with a roommate, etc.)
Where do you want to live when you finish college? (e.g. at home, in an apartment, with a roommate, etc.)
Transition 4: What type of job do you hope to get after finishing a college program?
What type of job do you hope to get after finishing a college program?
Transition 5: Tell us one thing about yourself that we may find surprising or interesting.
Tell us one thing about yourself that we may find surprising or interesting.
Transition 6: Is there anything else that you would like to share with our team? Any questions?
Is there anything else that you would like to share with our team? Any questions?

Acknowledgement of Application Completion
Application Completion
Please check one of the following
- I completed this application independently
- I had my answers transcribed on this application for me
- Someone other than myself completed this application
Name of Person*
Relationship to Applicant*
Signature*
Name
This field is for validation purposes and should be left unchanged.

Application

Step 1 of 9 - Student Information

Student Information

Family Information

Student Medical Information

Student Educational Information

Student Employment History

Student Funding Information

Personal Information for Interview Questions

Transition Plans

Acknowledgement of Application Completion

Mequon, WI

Ann Arbor, MI

Employer	Job Title	Start Employment	End Employment	Responsibilities	Wages	Reason for Leaving

Employer	Job Title	Start Employment	End Employment	Responsibilities	Reason for Leaving