Bridge to Independence- Certificate Program Admission ......Bridge to Independence- Certificate...

BridgetoIndependence

1Revised2-1-17

BridgetoIndependence-CertificateProgramAdmissionProcedureTheBridgetoIndependenceCertificateProgramatNichollsStateUniversityisaninclusive,comprehensiveeducationalandindependentlivingprogramwithavocationalcomponentforyoungadults,ages18to28withintellectualdisabilities(ID).Theprogramlengthiscurrentlytwoyearswithoptionaladditionalyearsforremediationorspecialemploymentopportunity.Bridgeisnotaplace,butaservicetodevelopleadershipandindependentlivingandemploymentskills.FullparticipationinallcomponentsofBridge,(i.e.:instructiontime,outofclassacademicsupports,participationincampusactivitiesandvocationaltraining)arerequired.LivingintheResidenceHallisoptionalbutrecommendedinmostcasesinorderforthestudenttofullyexperienceandlearnindependentlivingskills.CriteriaApplicationsmustbesubmittedonlyforindividualswhoareableto:•Functionwithoutattendantcareforpersonalneeds.•Independentlyandaccuratelymanageandadministertheirmedications.Further,theprogramwillconsideronlyindividualsthatmeetthefollowingcriteria:•Theapplicantmusthaveanidentifiedintellectual/developmentaldisability.•Theagerangeofstudentstobeacceptedis18-28yearsofage.•Theapplicantmusthavereceivedacertificateofcompletionorequivalentfromahighschoolprogram.•Theapplicantmustbeabletoreadprescriptions,storemedicationsaswellasself-medicate.•Theapplicantmustpossessenoughself-helpskillsandresponsibilitytobeabletosafelyandindependentlyfunctioninhis/herresidenceroomifutilizingNichollshousing,withminimaltonosupervisionafterprogramhours.•Theapplicantmusthaveacceptablesocialbehavior,verifiedbypreviousschools,family,and/oragencypersonnelaswellastheabilitytogetalongwithpeersandfollowrules.•Theapplicantmustbewillingtoparticipateinallhoursofinstructionandjobinternshipsduringtheweek,aswellasparticipateinoccasionalsupportedlearningafterhoursandonsomeweekends.•Theapplicantmusthaveastrongdesiretocompletetheprogram.•Theapplicantmustbefreeofanycommunicablediseasesthataretransmissiblebycasualcontactandallimmunizationsmustbeuptodate.Heorshemusthavehealthinsurance(i.e.privateorMedicaid).•Theapplicantmustbeabletoparticipateinapersonalinterview.•Theapplicantisrequiredtoprovideacurrent(within3years)evaluation(1508SpecialEducationEvaluationwithcurrenttesting)fromtheirexitingschoolboardPupilAppraisalCenterorprivateprovider•Theapplicantmusthavethenecessaryincomerequirements: oAcademicTuition,UniversityFees,RoomandBoard(ifapplicable),andBridgeFeeThesecanbepaidby:PrivatePay,PellGrants,scholarshipsandfundingfromLouisianaRehabServices oCourseMaterialsandTextbooks,asrequiredbyInstructor


2Revised2-1-17

Financialassistancemaybeavailable.ParentsshouldcompletetheFAFSAtodetermineiftheirstudentqualifies.Studentsunder24yearsofageareconsidereddependentsoftheirparent.Onceastudentis24,thestudentisnolongerconsideredadependentandshouldqualifyforaPellGrantontheirown.ApplicantswhoreceiveSocialSecurityBenefitscanalsousetheirmonthlyincometowardsthecostofoncampushousing.Goodreasonsforreferringastudent:•Theapplicantisinterestedinpursuingacademicinterestsonacollegecampus.•Theapplicantexpressesadesiretoliveindependentlyandisreadytomakeacommitmenttolearningindependentlivingskills.•Theapplicantexpressesadesiretobecomeemployedandiswillingtolearnvocationalskills.•Thefamilyissupportiveoftheapplicant’sdecisionandiswillingtopartnerwiththeBridgeProgram.Wrongreasonsforreferringastudent:•Thefamilywantstheapplicantoutoftheirhome.•Itseemslikeagoodideatoseparatetheapplicantfromtheirfamily.•Theapplicanthaslostthemotivationforlearningintheirpresentenvironment.•Theapplicantfeelsreadytoliveindependently,butthefamily,teacherandcasemanagerdoesnotfeeltheyareready.IftheapplicantdoesnotmeetthecriteriafortheBridgeProgram,theymayreapplyorareencouragedtosearchotheroptionsthroughtheircasemanagementagency,onlineexploration,andthroughtheirlocalschooldistricts.


3Revised2-1-17

STEP#1InitialCriteriaIftheinitialcriteriaaremet,theapplicantmayapplydirectly.Theapplicationinstructionsandformscanbeaccessedonlineatwww.Nicholls.edu/BridgetoIndependenceorbyemailing:Dr.MaryBreaudatmary.breaud@nicholls.eduTheApplicationPacketincludes:•BridgeApplication•PersonalStatementInstructions•ReferenceLetter(Print2oftheseforms)•ReferenceLetter-Waiverform•AuthorizationtoReleaseStudentInformationform•Applicant’sSkillInventory•GraffParentReadinessScale(GPRS)•ScopeofServicesSTEP#2ProgramTour:TheapplicantandfamilymustattendaBridgeProgramTour.Duringthetour,allaspectsandgoalsoftheprogramwillbereviewedanddiscussed.Atourofthecampusandresidencehallswilltakeplacewithanopportunityforquestionsandanswersbythestaff.TheProgramToursarescheduledthroughouttheyearandattendingaProgramTourismandatorybeforebeingconsideredfortheBridgeProgram.CalltheNichollsAdmissionsOfficeat985-448-4507toscheduleatour.AdmissionPacket:AllrequireddocumentsmustbesubmittedtogethertocompletetheprocessforadmissionconsiderationtoBridge.ItisimportantthatthemostcurrentinformationissubmittedinordertoascertainthattheBridgeProgramisanappropriateplacementandthatthestudenthasthecombinationofdesire,motivation,skill,andexperiencetobesuccessfulintheprogram.Documentsandcompletedformsrequiredattimeofsubmission:1.BridgetoIndependenceApplication2.Recent5”X7”photograph3.AuthorizationtoReleaseStudentInformationform-signed&dated4.BridgetoIndependenceSkillInventory5.PersonalStatement.Thisistheapplicant’sopportunitytostatereasonsforwantingtoattendBridgeandprovideadditionalpersonalinformation.Becreative!Thiscanbehandwrittenortypedbytheapplicant,aportfolio,videorecordedontoaflashdrive(noDVD/CD’sastheywillcrackinthemailingprocess),etc.Themaximumallowedtimeforvideorecordedpersonalstatementsis5minutes


4Revised2-1-17

6.HighSchoolTranscripts7.Highschooldiplomaorcertificate-copy8.Current1508specialeducationevaluationwithfullassessmentdataandexitIEPfromHighSchoolifcomingfrompublicschool9.TwoReferenceletters a.Professionalreferences,cannotbecompletedbyfamilymembers b.Mustbesubmittedinasealedenvelopewithappropriatesignatureonbacksecuringseal.10.ReferenceLetterWaiverform-completedbyapplicant11.ImmunizationRecords-copy12.LETTERSOFCONSERVATORSHIP-copy(ifapplicable)Submissionrequirements:•Submitallrequiredmaterialsinonepacket•Allofthematerialsmustbethoroughlycompleted•IncompleteapplicationswillnotbeprocessedSTEP#3OncethecompletedadmissionpackethasbeensubmittedandreviewedbytheBridgestaff,notificationletterswillbemailedtoallapplicants.Theletterwillstateeither:•Theapplicantandparent(s)orguardian(s)willbecontactedtosetupthenextstepintheprocess,whicharetheinterviews,or•Theapplicantwasnotselectedandmaybeencouragedtoreapply,or•Theapplicantisonawaitinglistintheeventaselectedstudentdoesnotacceptanofferofadmission.STEP#4–ApplicantswhoareselectedtobeinterviewedTheapplicantwillbeinterviewedseparatelyfromtheirparent(s)/guardian(s).Theinterviewprocesswillascertain:•Thatthestudenthasthedesire,abilityandmotivationtocompletetheprogramintheexpectedperiod.•Thatthestudent’sindividualneedscanbeappropriatelyservedbytheprogramstaffand/orcommunityresources.•Theprogramprovidestheleastrestrictiveenvironmentforthestudent•Thestudentispreparedtoentertheprogram.•Thestudentmeetstheentrancerequirements.


5Revised2-1-17

ResultsNotificationUponcompletionoftheinterviews,notificationwillbesenttoeachapplicantinatimelymanner.Pleasebepatient.Thisisadauntingprocess.Weareweighingourdecisionscarefully.Pleasemailcompletedpacketsto:

BridgetoIndependenceatNichollsStateUniversityAttention:Dr.MaryBreaud,Ed.D

CollegeofEducationP.O.Box2053

Thibodaux,LA70310


6Revised2-1-17

BridgetoIndependenceApplication

To ensure that the application is processed, applicant and/or parent/guardian must complete allinformation(Race&ethnicitytrackingisoptional). Dateattendedatourandprogramoverview:_____________________

IDENTIFYINGINFORMATIONApplicantName:

Birthdate:

SocialSecurity# StreetAddress: Age: City: State: Phone: () ApplicantsCellPhone:() Male/FemaleApplicant’sEmailAddress:

Driver’sLicense: Yes/No

U.S.Citizen: Yes/No CountryofCitizenship:

LanguagesSpokenintheHome: AreyouConserved: Yes/NoAreasConserved:

Conservator’sName:

RelationshiptoApplicant:

PARENTINFORMATIONParent#1orGuardianName: Address: EmailAddress: PrimaryPhone# () EmailAddress:

Parent#2: Address: EmailAddress: PrimaryPhone# () CellPhone#:()

SIBLINGINFORMATIONNameofSibling(s) Age LivesatHome

Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No


7Revised2-1-17

EDUCATION&SERVICES NameofInstitution CertificateorDiplomaHighSchool: CollegeorProgram:

HighSchoolCompletionorProjectedDate:

TheHighSchoolTranscriptsmustbeincluded(evenifinprogress)Indicatetheapproximategradelevel:

Math:______________Reading:__________________Writing:______________

DoestheapplicanthaveaLouisianaMedicaidwaiver? Yes/NoCaseManagementAgencyName: Phone#: ()Address: CaseManager’sName: EmailAddress: Fax#: DirectServicesProvider: Yes/No Direct

ServiceProviderAgencyName:

Address: Phone#: ()EmailAddress: Fax#: ()

IsthestudentaLouisianaRehabServicesClient?

Yesq Noq InProcessq

Address:

LRSCounselorName: Phone#: ()

Email: Fax#: ()


8Revised2-1-17

DoyoureceiveSSI:

Yesq Noq InProcessq Willapplyat18q

IfYes,NameofPayee: AmountPerMonth: $

VOLUNTEER&COMMUNITYSERVICE

Organization DescriptionofActivityandDuties Hours/PerWeek

WORKEXPERIENCEBusiness/Organization Duties DatesEmployed Hrs/Wk

MEDICATIONINFORMATION


9Revised2-1-17

DoYouTakeMedication(s): Yesq Noq

NeedsAssistanceWithMedications:Yesq Noq Ifyes,pleaseexplain:

Medication(s) TimesofDay/Week Purpose

PHYSICALSUPPORTSUsesManualWheelchair Yes No

UsesElectricWheelchair Yes No

UsesaWalker Yes No

UsesaCane Yes No

UsesHandrailsinBathroom&Shower Yes No

RequiresOtherSupports.Ifyes,pleasespecify:


10Revised2-1-17

BEHAVIORCausedpropertydamageincludingfires YES NOPhysicallythreatenedand/orattackedothers Verballythreatenedothers Self-injuriousbehavior Mistreatinganimals Elopement Lying Fabrication Inappropriatesexualbehavior Stealing Priorarrestorprobation Tobaccouse/abuse Marijuanause/abuse Druguse/abuse Alcoholuse/abuse Seizure(s) Currentgangbehavior,affiliationanddesires Incontinenceproblems Requiresattendantcare Consistentlyfollowsverbaldirections Ifyestoanyofthebehavioralandorself-careissues,pleaseexplainindetail.Includethemostrecentdate(s)oftheoccurrence(s)andseverity(useanothersheetformorewritingspace):


11Revised2-1-17

RACE&ETHNICITYTRACKINGOPTIONAL

ForpurposeofdatacollectionforBridgetoIndependencefunding,pleasemarkthebox9es0thatbestdescribestheapplicant’srace/ethnicitycategoryorwhichhe/sheidentifieswith:A___ AsianorPacificIslander:PersonshavingoriginsinanyofthepeoplesoftheFarEast,

SoutheastAsia,theIndiansubcontinent,orthePacificIslands.Thisareaincludes,forexample,China,Japan,Korea,thePhilippineIslandsandSamoa.

B___ AfricanAmerican(notofHispanicorigin):Personhavingoriginsinanyoftheblackethnicgroups.

H___ Hispanic:PersonshavingoriginsinanyoftheMexican,PuertoRican,Cuban,CentralorSouthAmericanorotherLatinCultures,regardlessofethnicity.

I___ NativeAmericanorAlaskanNative:PersonshavingoriginsinanyoftheoriginalpeoplesofNorthAmerica,andwhomaintainculturalidentificationthroughtribalaffiliationorcommunityrecognition.

W___ Caucasian(notofHispanicorigin):PersonshavingoriginsinanyoftheoriginalpeoplesofEurope,NorthAfricaortheMiddleEast.

IhavecompletedthisBridgetoIndependenceapplicationtruthfullyandtothebestofmyknowledgeallinformationisaccurate.ApplicantSignature:_________________________________________________Parent/GuardianSignature:____________________________________________Date:____________________


12Revised2-1-17

PersonalStatementInstructions

Animportantpartoftheadmissionsprocessisthepersonalstatement.ThisisyouropportunitytoshinebytellingwhyyouwanttocometotheBridgeProgramaswellassomethingaboutyou.Thisincludesfactsaboutyourbackground,goals,andanyotherinformationthatyouthinkwillhelpuslearnmoreaboutYOU.BECREATIVE.Thepersonalstatementcanbehandwrittenortyped,aportfolio,videorecorded,etc.Anyelectronicsubmissionsmustbeonaflashdrive,asaDVD/CDwilleasilybreakduringthemailingprocess.Themaximumallowedtimeforvideorecordedpersonalstatementsis5minutes.Materialssubmittedwillnotbereturned.Yourpersonalstatementmustincludenumbers1–4and11below.5-10areoptional.1.Yourname.2.WhyyouwanttobeacceptedintotheBridgetoIndependenceProgram.3.Specialinterests.4.Includespecificareasyouwanttolearnaboutwhileintheprogram.5.Describe1-2opportunities/tripsyouhavetakenwithoutyourparents/family.Include: •#ofdays •Destination •Purpose(e.g.vacation,conference,etc.) •Howyoufeltaboutbeingaway •Whoyoutraveledwith •Modeoftransportation6.Thingsyouliketodoinyourfreetime.7.Inschool,nameyourfavoritesubject(s)andyourleastfavoritesubject(s).8.Yourstrengths.9.Areasyouwouldliketoimproveupon.10.Describewhatyoulearnedandenjoyedaboutanypaidand/orvolunteerworkexperience.11.Describewhatyouseeasyourideallifeinthefuture? •Wherewouldyouliketowork? •Wherewouldyouliketolive?ACity,Apartment,condominium,homeandwouldyouliketo livewitharoommates,familyoralone.


13Revised2-1-17

ReferenceLetter

NameofApplicant:______________________________________________________isapplyingforadmissiontotheBridgetoindependenceProgram(Bridge)atNichollsStateUniversity,inThibodaux,Louisiana.Bridgeisaninclusive,comprehensiveeducationalandoptionalresidentialprogramwithavocationalcomponentforyoungadultswithintellectualandotherdevelopmentaldisabilities.Theprogramcombinesuniversitylevelcourseswithindependentlivingskills,vocationalskills,socialandrecreationalopportunitiesontheNichollsStateUniversityCampusandinthecommunity.Thegoalistoassistthestudentsindeterminingtheirfutureinallaspectsoftheirlives.TheprogramprovidesthelifeandjobskillstrainingnecessaryforBridgestudentstoleadindependentfulfillingliveswithlifelongfriends.Withinyourletterofrecommendation,pleaseincludethefollowinginformation:•Youroccupation•Lengthoftimeyouhaveknowntheapplicant•Thecontextyoufirstbecomeacquaintedwiththeapplicant•Theapplicant’smostexemplarytraits•Areasthatcoulduseimprovement•Concernsyouhaveabouttheapplicant(e.g.behavioralissues)•ReasonswhyyoufeeltheapplicantisagoodcandidatefortheBridgeprogram.Returnyourletterofrecommendationinasealedenvelopetothestudent.Shouldyouhaveanyquestionsregardingthisreferenceorourprogram,[email protected]


14Revised2-1-17

ReferenceLetterWaiverFormApplicantName:

Applicant’sName:__________________________________________________________ApplicantStatement:IunderstandtheselettersofevaluationaretobereceivedandmaintainedinconfidencebyTheBridgetoIndependenceProgramatNichollsStateUniversity,Thibodaux,Louisianaforadmissionconsideration.IherebyexpresslywaiveanyandallrightsImighthaveofaccesstothisevaluationundertheFamilyEducationRightsandPrivacyActof1974,and/orallotherlaws,regulations,orpolicies.IunderstandthattherightsIamwaivinginclude,butarenotlimitedto,therighttoinspectandreviewthisletter;therighttohaveacopyofthislettermadeformyuse;andtherighttorequestanamendmentofthisletter.________________________________________________________________________ApplicantorGuardian’sSignature/DateBridgerequirestworeferenceletters.Onemustbefromateacherorjobsupervisorandanotherfromapersonwhoknowsthestudentwell,butnotafamilymember.Individualswritingthelettersmustplacethereferenceletterinasealedenvelope.


15Revised2-1-17

CaseManagementStateAgencyReferralForm

PleasereviewadmissionscriteriabeforereferringyourclienttotheBridgetoIndependenceProgram(Bridge)atNichollsStateUniversity.

Attachthemostcurrentstatereportforthisclient.ClientName:UCI#:Age:Diagnosis:Fax:()Address:NameofServiceCoordinator:Phone#:()Email:NumberofMonthsorYearstheApplicanthasbeenyourClient:ClientName: ID/Case#: AGE: Diagnosis: NameofAgency: Fax#: ()Address: NameofCaseManager: Phone#: Email: Numberofmonthsoryearstheapplicanthasbeenyourclient?: 1.Whataretheclient’smostexemplarytraits?2.Whataresomeareasforimprovement?3.Stateanyfactors/characteristics/behaviorsofthisclientthatwouldbeaconcernforBridge?Pleasebeveryspecific.4.Statereasonswhyyoufeeltheclientisorisnotappropriate/readyforBridgeatNichollsState?


16Revised2-1-17

5.Isyourclientreadytomoveoutofthehouse?Explainwhyorwhynot.6.Doyoufeeltheclient’sparents/guardian,aresupportiveoftheirson/daughterattendingBridge?Explain.7.Generally,howoftenwouldyousaythisclient’sparent’scontactyou?7a.When,you’recontactedbythisclient’sparents,whattypesofnegativeorpositivesituationsareyouaddressing?8.Doyoufeeltheclient’srightsandchoicesasanadultarebeingrespectedandsupportedbyhis/herparents/guardians?Pleasegiveexamples.9.Doestheclienthaveastrongsupportsystem?Statewhotheyareandhowtheysupporttheclient.


17Revised2-1-17

Checktheboxforallthatapplytotheclient’shistoryof:_______________________________Causedpropertydamageincludingfires YES NOPhysicallythreatenedand/orattackedothers Verballythreatenedothers Self-injuriousbehavior Mistreatinganimals Consistentlyfollowsverbaldirections Elopement Lying Fabrication Inappropriatesexualbehavior Stealing Priorarrestorprobation Tobaccouse/abuse Marijuanause/abuse Druguse/abuse Alcoholuse/abuse Seizure(s) Currentgangbehavior,affiliationanddesires Incontinenceproblems Requiresattendantcare Resentmenttowardsparent(s) Ifyestoanyofthebehavioralandorself-careissues,pleaseexplainindetail.Includethemostrecentdate(s)oftheoccurrence(s)andseverity(useanothersheetformorewritingspace):


18Revised2-1-17

Certification:Ihavecompletedthisapplicationtruthfully,andtothebestofmyknowledgeallinformationisaccurate.CaseManagementAgencyServiceCoordinator:__________________________________Date:_____________SignatureSubmissionofRegionalCenterReferralForm:Yourclient’scurrentAnnual/QuarterlyreportMUSTbesubmittedwiththisform.ThisreferralMUSTaccompanytheBridgeAdmissionPacketwhenitisreceivedbytheprogram’sofficeforreview.Returnall3documentstoyourclientinanenvelopesealedasdirectedbelow.EnvelopeSealingInstructions:Oncecompleted,pleaseplacethisreferralinanenvelope,sealtheenvelopecompletely,writeyournameacrosstheoverlapoftheflap/envelopebody.Finally,placeagenerousamountofcleartapeoveryoursignature.


19Revised2-1-17

AuthorizationtoReleaseInformation

Name(s)ofAgency,HighSchool,Professional,Medical(allthatapply)

Applicantname: DOB: Today’sDate:

BridgetoIndependenceatNichollsStateUniversityrequeststhefollowinginformationregardingtheaforementionedpersontoaidinprovidingqualityservices:Medicalinformation:

• DiagnosticInformation• CurrentMedications• TreatmentHistory• Assessments/Evaluations

PsychologicalInformation:• Diagnosticinformation• CurrentMedications• Treatmenthistory• Assessment/Evaluations

o IndividualEducationPlan(IEP) o IndividualTransitionPlanforEmployment

o EducationalAssessments/1508Evaluation

o SocialAssessmentInformation

o EmploymentAssessment(LouisianaRehab.Services)

o CaseManagementAgencyReports/Plan

o Other(describe): Bysigningbelow,IunderstandthatBridgetoIndependenceatNichollsStateUniversityshallshareinformationwiththereferringagencyandanyotheragenciesasitpertainstotheprogramservicesrenderedtotheaforementionedpersonandhis/herhealthandwelfare.IauthorizeBridgetoIndependencetorequestinformationfromthereferringagency,schoolandotherpertinenthealthcareprovidersthatisdeemedpertinenttoservicesprovided.IalsoauthorizethereleaseofinformationfromthereferringagencytoBridgetoIndependencetoaidinprovidingsuchservicesonlyuntilIcompletetheprogramorforthreeyearsfromsignaturedate(whichevercomesfirst).ApplicantSignature:_________________________________________Date:________________GuardianSignature:_________________________________________Date:________________BridgeStaffSignature:_______________________________________Date:________________


20Revised2-1-17

ApplicantSkillInventoryApplicantName:____________________________________________________Personassistingorratingapplicant:_____________________________________Relationship:________________________________Date:_________________

UsethisrubrictoratetheapplicantwiththeattachedSkillInventory

WithNoAssistance

Applicantisabletoaccomplishthetaskwithoutassistance

LittleAssistance

Applicantrequires25-50%assistancetoaccomplishthetask

SignificantAssistance

Applicantrequires50-75%assistancetoaccomplishthetask

WithNoReminders

Applicantisabletoaccomplishthetaskwithoutreminders

FewReminders

Applicantisabletoaccomplishthetaskwithreminderson25-50%ofthesteps

ManyReminders


IsStilllearning


N/A

ThisparticulartaskisnotapplicabletothisApplicant

PlaceamarkintheappropriateboxindicatingtheLevelofAssistanceANDtheLevelof

Remindersneededtoaccomplishtheskill.Seeexampleonthenextpage.Pleasefollowtheexampleprovidedatthetopofthenextpage.


21Revised2-1-17

AcademicsSkillInventory

Academics:Writing WithNoAssistance

LittleAssistance


WithNoReminder

FewReminders

ManyReminders

IsStillLearning

N/A

Writersname Write/copiesallletters Writescompletewords Writesshortsentences Correctlyusespunctuation Drafts,revise,edits

Academics:Reading WithNoAssistance

LittleAssistance


WithNoReminder

FewReminders

ManyReminders

IsStillLearning

N/A

Identifiesletters Recognizesfamiliarwords/names Appliesreadingstrategies(sentencestructure,meaning,phoneticclues)

Readschapterbooks Readsbookssilently

Academics:ListeningComprehension

WithNoAssistance

LittleAssistance


WithNoReminder

FewReminders

ManyReminders

IsStillLearning

N/A

Retellsasimplestory

Canretellthebeginning,middle,andendofstories

Abletoretellsettings,characters,problems,majoreventsandsolutionofstories


22Revised2-1-17

Academics:General WithNoAssistance

LittleAssistance


WithNoReminder

FewReminders

ManyReminders

IsStillLearning

N/A

Keepstrackofassignmentsandduedates

Keepstrackofassignmentsandduedates

Bringspropersuppliestoclass Completesmultiplechoiceexams Completeswrittenexams


23Revised2-1-17

WHATARETHISAPPLICANT’SNEEDS?

Whatarethestudent’sstrengthsandtheirareasofneed?Pleasedescribeindetailanypreviouslyusedsupports,accommodations,and/orbehavior/managementplan.Listanytypesofassistivetechnologyutilized.Ifyouneedmorespace,pleaseattachanadditionalpage.


24Revised2-1-17

WHATWOULDANIDEALDAYBELIKEFORTHEAPPLICANT?

Whatwouldanidealdaybelikefortheapplicant?Pleaseincludeallcurrentpertinentrecreationalactivitiesaswellasareasofinterest.Ifyouneedmorespace,pleaseattachanadditionalpage.


25Revised2-1-17

WHATISTHEAPPLICANT’SEDUCATIONALHISTORY?

Pleaselistanyeducationexperiencesthatwillgiveapictureofhowtheapplicantlearnsbest.Whereinschoolwastheapplicantmostsuccessful?Pleaseelaborateonstrengthsandareasforimprovement.


26Revised2-1-17

GraffParentReadinessScale(GPRS)

Thisscalehelpsdeterminethefamilies’readinessforthestudentwithanintellectualand/ordevelopmentaldisabilitytoattendapost-secondaryprogram.

Pleasecirclethefamily/guardian’sresponse.

1=Istronglyagree,2=Iagree,3=Ineitheragreenordisagree,4=Idisagree,and5=Istronglydisagree.

1.Iexpecttoknoweverythingmystudentsdoesattheuniversity.

StronglyAgree12345StronglyDisagree

2.Iexpectone-onesupportallday.


3.Iworryaboutmystudenttalkingtootherstudentsunsupervised.


4.Iworryaboutmystudentcrossingthestreet.


5.Ineedtoknowthehomeworkassignmentforeachclass.


6.Ineedtoknowthecalendarofactivitiesofferedtomystudent.


7.Iwouldliketospeakwithmystudent’ssupportstaff.


8.Iwouldliketoattendclassestoseemystudentinteractwithothers.


9.Itrustmystudent’sjudgment.


10.Itrustmystudent’sabilitytohandlesmallsumsofmoney.


11.Iknowmystudent,withsupport,willdevelopfriendships.



27Revised2-1-17

GraffParentReadinessScale(GPRS)Continued

12.Iknowmystudent,withsupport,willtrynewopportunities.


13.Mystudenthastheabilitytohandlefrustration.


14.Mystudenthastheabilitytoseekassistance.


15.Often,Iamincontactwithmystudentsmorethan3timesaday.


16.Often,Iamtellingmystudentwhattodoandsay.


17.Icheckuponmystudent.


18.Ichecktoseeifmystudenthasthecorrectfacts.


19.Ibelieve,Iknowwhatisbestformystudent.


20.Ibelieveapostsecondaryeducationisimportantformystudent.


21.Ifeelthatmystudentknowswhatisbestforhimorherself.


22.Ifeelthatmystudentwantstoattendtheuniversity.


23.Mystudentwillliveindependentofourfamilyaftergraduation.


24.Mystudentwillhavemeaningfulemploymentaftergraduation.


25.PersonCenteredPlanningwillhelpmystudentachievetheirgoals.



28Revised2-1-17

ScopeofServices

TheBridgeProgramisdesignedtoaddresstheuniqueneedsofstudentswithintellectual/

developmentaldisabilities.

ACADEMICS

ParticipantsintheBridgeCareerprogramatNichollsStateUniversityarenotenrolledthrough

traditionalmeans,asthematriculated,degreeseekingstudentsofNichollsStateUniversityare.Bridge

studentsenrollthroughtheBridgetoIndependenceProgramandreceiveaCertificateofAchievement

andan“UnofficialNichollsStateTranscript”throughtheBridgeCareerProgram.

HEALTHSERVICES

BridgestudentshaveaccesstocampusStudentHealthCenterservices.Theseservicesareforimmediate

firstaid/onsetcareonly.Bridgestudentsneedtomakeothermedicalarrangementsforlongtermcare

issues.Likewise,counselingandpsychologicalservicesprovidedbytheStudentServicesarealsofor

immediateemergencyinterventionsonly.Studentswithpre-existing/ongoingconcernsshouldmakethe

necessaryarrangementsfortheseknownissues.Bridgedoesnotendorseanyphysicianorcounselor

andthereforedoesnotmakereferrals.AspartoftheCollegeofEducation,individualandgroup

counselingservicesmaybeavailabletoBridgestudents.Theseservicesareprovidedbygraduatelevel

counselingstudentssupervisedbyaPh.D.instructor.OnceagainBridgedoesnotendorsetheseservices

andparticipationisoptional.

CODEOFCONDUCT

AllBridgestudentswillbeexpectedtoabidebythestudentcodeofconductasoutlined,

http://www.nicholls.edu/sja/files/2015/06/Code-of-Student-Conduct-Handbook.pdf.Bridgestudents

willfollowpoliciesofthejudicialsystemandtherecommendationsoftheVicePresidentofStudent

AffairsaswellastheBridgeAccountabilityPolicy.Anyresultingdisciplinaryactionwillfollowin

accordancewithNichollsStateand/orBridgepolicies.Thesepoliciesincludepermanentortemporary

expulsionofastudent.Parents/guardianswillneedtoacknowledgethattheywillbeactivemembersin

holdingtheirstudentaccountablefortheiractions.

PARENTS/GUARDIANS

ParentalinvolvementiscrucialforstudentsuccessintheBridgeProgram.Parentswillbeincorporatedin

manyimportantdecisionsthattheirstudentmaymakethroughBridgeIndividualPlanningMeetings.


29Revised2-1-17

However,theremaybetimesthatBridgeisboundbyconfidentialityorjudicialrulings,andmaybe

unabletoshareinformationaboutthestudentwithouthis/herpermission.TheBridgeProgramgoalis

tosupportstudentsinbecomingindependentadults,capableofself-advocacyandself-determination.

Parentsmaynotalwaysagreewiththedecisionsthattheirstudentsmake,butshouldmaintaina

positiveandopenrelationshipwithallparties.

________________________________________________________________________

Applicant’sNamePrinted Applicant’sSignature Date

___________________________

Parent/GuardianSignature

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