Perkins School for the Blind: Transitions Programs Application Form

Transitions Center Application - Page 1 of 8

Programs

Compass: College assessments, readiness and success - a nine-month virtual program for visually impaired high schoolers aspiring to college. Compass helps students explore and develop the essential academic and blindness skills for their post-secondary goals.

Pathfinder: Life skills, work, and community connection - provides ongoing enrichment opportunities for high school students with goals of meaningful employment after graduation – through virtual group work, 1:1 virtual conversations, and in-person workplace explorations around the Boston area.

Navigator: Post-secondary transition counseling - provides personalized coaching for high school graduates who are visually impaired and seeking guidance in their next steps, including post-secondary education planning, and employment and career exploration.

Which program are you interested in (please select only one)

Student

First Name	Last Name
Student Birthdate (MM/DD/YYYY)	Student Phone (enter as ###-###-####)
Student Email	Country Of Citizenship
Street Address	City
State	Zip/Postal Code

Pathfinder Program - Additional Student Information

Do you/your student have self guardianship?

Navigator Program - Additional information about you

Are you a first generation student?

Primary Language spoken at home

Family Contacts

Relation to Student	Resides with the applicant?
First Name	Last Name
Phone number (###-###-####)	Email
Country Of Citizenship	Street Address
City	State
Zip/Postal Code	Would you like to include an additional family contact?

Additional Family Contact

Relation to Student	Resides with the applicant?
First Name	Last Name
Phone number (please enter as ###-###-####)	Email
Country Of Citizenship	Street Address
City	State
Zip/Postal Code

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Current Educational Information

Current School

Please explain other

Current Grade

Anticipated Year of Graduation

Start Date of attendance at current school (enter as MM/YYYY)

Name of Teacher of the Visually Impaired

Email of Teacher of the Visually Impaired

Student Educational Information

High School Attended

Please explain other

Do you have a high school diploma or a GED?

Year of Graduation/GED

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General Information

Please describe your/your student’s visual diagnosis, including age of onset, and age of start of services. Include relevant diagnoses, as appropriate

Please include any other diagnoses, including learning disabilities, impactful medical considerations that may help the our Team understand you/your student's overall profile.

Compass Program - Short Answers About Your Student

We want to get to know your student and their interests, plans, and goals. Please complete these questions.

What does your student enjoy about school? Please share details about your student's general academic interests

What are your student's preferred activities inside and outside of school? Please include activities and interests they enjoy, such as music, art, physical fitness and/or meaningful family activities, volunteer activities and other commitments.

Does your student have a modified curriculum? (i.e. reduced work, output, adjusted test questions, etc.)

What top three skills do you believe your student needs to develop in order to be ready for life after high school? Please explain.

Have you discussed Transitions goals with your student? Have any Educational Team members been part of these discussions? (i.e. TVI, Special Ed team, or Transition Counselor) Please share specifics.

In what areas do you see your child's strengths as they anticipate college and independence? In what ways are you concerned, or feel that he's unprepared? What areas do you feel unprepared? Consider these skills as you answer this question: (Advocacy, O&M, Executive Functioning, Social Skills, etc)

When thinking about your student’s post secondary journey, where do you feel there is highest need for growth? Consider these skills as you answer this question: (Advocacy, O&M, Executive Functioning, Social Skills, etc)

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Compass Program - Short Answers About Your Student Continued (Vision)

Please describe ways that your child's vision impairment currently impacts activities of daily life, and academic functioning.

Please list any additional disabilities including learning differences.

To what extent does your student understand their visual impairment and its implications on their life and learning?

Compass Program - Short Answers About Your Student Continued (Reading and Writing)

What is your student’s current reading level? If unknown, we encourage you to have this discussion with your student’s educational team.

At this time, what is your student's preferred reading method?

On which device does your student read?

What is their reading rate on their preferred reading method? If unknown, we encourage you to have this discussion with your student’s educational team.

What is their preferred writing method?

What is their typing speed? If unknown, we encourage you to have this discussion with your student’s educational team.

Where is homework completed?

Homework assistance level

How much time do they spend on homework per week?

Compass Program - Short Answers About Your Student Continued (Technology)

Is the student independent in their use of technology?

Describe the assistive technology that your student currently uses for academic work, including screen readers, braille notetakers, magnifiers, and any other technology used on a regular basis.

When were these devices introduced? Does your student receive specific training outside of school?

Vision

Are you/your student legally blind?

Are you/your student registered with your state commission for the blind?

If registered with the state commission for the blind, please select the State

If registered with the state commission for the blind, do you know the name of your/your student's Vocational Rehabilitation Counselor (VRC)?

Vocational Rehabilitation Counselor Information

First Name	Last Name
Work Email	Organization Name

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Additional Tech Information

This section helps us learn about how you/your student discovered our program, and what resources you/your student has available.

Are you/your student independent using a laptop?

If you do have experience on a laptop computer, can you work on it independently to read, write and work online?

If you answered "other" above, please describe here.

Are you/your student independently able to sign into a Zoom or GoogleMeet meeting on their preferred device? Please select the description that best describes you/your student's independence in the use of virtual meetings.

If you answered "other" above, please describe here.

What is your estimated typing speed on a keyboard (such as on a laptop)

Do you have access to dependable Wi-Fi to support virtual assessments and coaching?

Compass Program - Skills

The next three sections: Daily Living Skills, Social Skills and Organization Skills contain questions with radio button responses. If using a screen reader, please be advised you may need to turn off the virtual cursor before tabbing through the form to mark the appropriate radio button for each question.

Daily Living Skills

	Not Attempted	Requires Support	Independent*
Doing Laundry
Caring for personal hygiene (bathing, hair care , brushing teeth, etc. )
Self-administration of medications
Maintaining a clean environment
Choosing what to wear
Preparing simple meals
Shopping for wants/needs
Managing money

*Independent: Can accomplish task without any additional assistance at all. Not to set up, not to turn on, not to point to a starting point.

Social Skills

	Not Developed	Developing	Strong
Making new friends
Getting along with others
Reading other people's emotions
Taking turns in conversation
Engaging with others
Being part of a team
Communicating wants and needs to peers
Being a leader
Communicating wants and needs to older adults

Organization Skills

	Not Developed	Developing	Strong
Using a planner or track list
Finishing assignments on time
Breaking down large tasks into manageable steps
Staying focused
Avoiding procrastination
Using time wisely
Keeping electronic and/or print materials organized
Keeping track of belongings
Maintaining a clean space (desk, locker, bedroom)

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Person Who Is Completing the Application

Relationship to applicant

Please explain other

First Name

Last Name

Email

Phone number (enter as ###-###-####)

Organization Name

How did you hear about us?

Please explain other

Word of mouth via

If you received assistance completing this form, please explain. (minimum 10 words)

If the student completed this application with your assistance, what level of assistance did you give them (if any)?

Page 8 of 8

Documents

Submit application materials here or by mail or email. File types that can be uploaded:

.doc (Older Microsoft Word format)
.docx (Current Microsoft Word format)
.pdf (Adobe PDF)
.odt (Open Office word processor document)

If you have any questions about required documentation, please contact admissions@perkins.org

Required - Transcript

Please attach or upload unofficial transcripts from all schools attended, Grade 9-current.

Supplemental Application Materials

Individual Education Plan (IEP)

Standardized testing (SAT/ACT)

Educational, Psychological/Neuropsychological, and Speech and Language Evaluations (preferred but not required)

Upload Medical Documentation

Optional Application Documents

Please share any documentation that will help us to get to know you/your student. (e.g. Forms or documents about your/your student's diagnosis that you would like to share with program staff to better understand your needs.)

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Thank you

Thank you for completing the Transitions Programs Application Form. An Admissions Team member will be in touch with you shortly to discuss next steps. Questions? Please contact admissions@perkins.org

Compass Campaign ID

Navigator Campaign ID

Pathfinder Campaign ID

ProgramID