Brenham Independent School District

Project|SEARCH

Candidate Application

2017-2018

Brenham Independent School District

Baylor Scott & White Healthcare

Candidate Name:
Address:
Phone:
Email Address:

Application Purpose & Guidelines

The purpose of this application packet is to outline the skill set of the Project SEARCH student candidate. This application enables the Selection Committee* to properly assess each student candidate’s interests, skills, abilities and background. A parent, student, counselor, teacher or employer may be contacted by the Selection Committee to gather additional information. Our goal is to select students who will be successful in a Project SEARCH program and reach the outcome of competitive employment.

The Selection Process includes the following guidelines:

All students are encouraged to attend an Open House and must visit the host business site to observe the culture, possible rotations and meet the Instructor and Job Coaches prior to being selected to participate in Project SEARCH.

Submit the completed application to the address on your cover letter by Thursday, March 9, 2017.

The Selection Committee will review the applications, and will schedule Interviews for each applicant. Eligibility to receive services from the Texas WORKFORCE Solutions is required. For information on TEXAS WORKFORCESolutions eligibility, please contact Leslie Abbott, Vocational Rehabilitation Services Counselor at

If accepted, an Individual Education Plan (IEP) will be developed with the IEP team for the 2017-2018 school year.

If accepted, students must pass a criminal background check and drug screen, and will be required immunizations according to Baylor Scott & White Healthcare.

The program will follow the Brenham ISD school calendar and hours are 8:00-2:30 each day.

* Please note:

The Selection Committee will include the Host Site Liaison, the Project SEARCH Instructor, Project SEARCH Job Coach, Project SEARCH School District Liaison, Project SEARCH representatives from; TEXAS WORKFORCE Solutions, and Community Rehabilitation provider.

Order of selection will be:

Students who have finished their necessary credits for graduation
Students who will benefit from participation in a variety of internships
Students who desire to gain competitive employment at the end of the Project SEARCH program
Students who have been accepted to TEXAS WORKFORCE SOLUTIONS

Project SEARCH Application Packet Checklist

*PLEASE NOTE*

ALL THE REQUIRED DOCUMENTS MUST BE COMPLETED AND SENT TOGETHER FOR APPLICATION TO BE CONSIDERED. IF YOU NEED ASSISTANCE COMPILING THIS INFORMATION, PLEASE CONTACT YOUR SCHOOL DISTRICT STAFF.

Completed Application Packet

Current Individual Education Plan (IEP) including Transition Goals

High School Transcript

Attendance Record

Career Assessment–most recent vocational evaluation or career interest survey

Copy of State ID or Driver’s license

Shot/Immunization Record or Copy

Return completed Packet to:

High SchoolProject SEARCH Coordinator: High School

Sharon Machac, Kim Niesig

Project SEARCH CoordinatorBrenham ARD Facilitator

Brenham ISD Brenham High School

1200 Carlee Drive 1200 Carlee Drive

Brenham, Texas 77833Brenham Texas 77833

APPLICATION FOR ADMISSION

A. / APPLICANT PERSONAL INFORMATION:
Name:
Last / First / Middle
SS# or ID#:
Address:
Street / City / Zip Code
E-mail Address: / Cell/Home Phone:
Date of Birth: / Male / Female
PARENT/GUARDIAN PERSONAL INFORMATION:
Email address: ______
Father Name : ______
Work number : ______
Mother Name:______
Work number: ______
Home Address:
Street / City / Zip Code
Cell/Home Phone: / Work Phone:
B. / STUDENT/PARENT INFORMATION:
1. / Acceptance into the Project SEARCH Program is dependent upon Selection Committee review.
2. / Release: The student recordsconcerning my son/daughter may be transferred to Baylor Scott & White Healthcare for review by the Project SEARCH program staff and Selection Committee Team Members.
3. / Equal Opportunity: Career placement will be made without regard to race, color, national origin, sex, age, religion or presence of a disability.

A two-week trial period will be required of all candidates who are accepted into the Project SEARCH program. The parent and student agree to comply with this procedure.

Student Signature: / Date:
Parent/Guardian Signature: / Date:
C. / REFERRAL SOURCE INFORMATION:
Name:______ / Agency/School:______
Please attach high school transcript,
previous two year’s discipline record and most recent report card
Cumulative GPA / _____
Does the student have the necessary credits for graduation? / Yes / No
Days Absent: / 11th Grade / ______/ 12th Grade / ______
Comments about Attendance:
Comments Regarding Work Performance:
Signature: / Date:
Title:

D. EMPLOYMENT BACKGROUND:

When you are hired for paid employment do you want to work? Please check both if applicable: Full-time: Part-time:

List jobs you do or have done in school or in the community. List most recent first:

Start Date: / Employer: / Paid Employment: /  Yes /  No
Supervisor: / Contact Number:
End Date: / Task 1: / Task 2:
Task 3: / Task 4:
Start Date: / Employer: / Paid Employment: /  Yes /  No
Supervisor: / Contact Number:
End Date: / Task 1: / Task 2:
Task 3: / Task 4:
Start Date: / Employer: / Paid Employment: /  Yes /  No
Supervisor: / Contact Number:
End
Date: / Task 1: / Task 2:
Task 3: / Task 4:

Have you ever been fired from, let go from or asked to resign from a job?

Yes / No

If yes, please explain:

Have you ever quit a job?

Yes / No

If yes, please explain:

After the Project SEARCH program is completed, do you plan on getting and maintaining a

Full time job / Or a Part time job?
Where or with what kind of Organization? / How many days/ hours per week ?
Where do you plan on living? / Home / Friends Other _____

E. OTHER EXPERIENCE

Does the student have previous volunteer experience?

Organization:______

Volunteer duties:______

School_Work: ______

F. UNIFORM:

Please provide sizes for uniform ordering purposes:

Pants:______Shirt:______Shoes:______

G. TRANSPORTATION:

How do you plan to get to Project SEARCH?

Walk / Other / Parents / Drive Self / School Transportation

H. SERVICE AGENCIES:

Do you have a Vocational Rehabilitation Counselor? (VR Counselor)

Yes / Name / Phone Number:
No

Are you receiving Social Security benefits?

Yes / No

I. INDEPENDENT LIVING:

Medications taken by student:

Medication / Dosage / Time of day

List any health or medical issues that may impact a successful job placement:

Please list any other challenges or limitations that impact your ability to keep a job:

Please explain challenges, limitations or accommodations needed:

J. STUDENT RESPONSE QUESTION:

Why do you want to come to Project SEARCH? (Complete in your own words or have someone write your thoughts for you, using your own words)

K. REFERENCES:

List Three Non-Family References (People who have firsthand knowledge of your work performance):

Name / Title / Phone Number / Email Address
1.
2.
3.

L. PREPARER:

If this application has been completed by someone other than the student, please provide the following information and sign:

Name / Title / Phone Number / Date
Signature

M. BEHAVIORAL SUMMARY:

Do you have any behaviors that might impact a successful job placement?

Yes / No

Please Explain:

Has the student ever been placed on a behavioral plan while in high school?

If yes explain:

______

Has the student ever been suspended /excluded/removed from high school?

If yes, please describe:

______

Has the student been involved in the court system? Yes No

If yes please describe: ______

Student Participation Contract*

I, ______, understand that I have been accepted into the Project SEARCH program and must abide by the following terms and conditions:

I understand Project SEARCH is a one year training program and I will actively pursue competitive employment when I have completed the program.

I will complete at least three unpaid job rotations within the host business.

I will attend the program every day as scheduled.

Monday through Friday, 8:00am-2:30 p.m.

I understand that the Project SEARCH program correlates with the Brenham ISD

school calendar.

I will dress according to the dress code uniform requirements of the assigned host site and or rotation.

I will call my instructor and departmental supervisors when I am absent or tardy.

I understand that I am responsible for transportation to the host site.

I will follow all the policies & procedures established by the program and the host business.

I will attend and be an active participant at our monthly meetings with my rehabilitation counselor, parents, teachers, and business staff.

I will actively pursue employment

I will receive a Project SEARCH Certificate of Completion when I complete the program.

I understand that the desired outcome for me in Project SEARCH is full/part time employment in the community.

I have read the above terms and conditions and agree to accept my placement in the Project SEARCH program. I understand that I may be asked to leave Project SEARCH if I fail to follow the terms and conditions.

______

Student Signature Date

______

Parent/Guardian Signature Date

*The student will be asked to sign this upon acceptance into the program at the IEP meeting.

YES / NO
I will be 18-21 years
On August 2017
I will have completed my high school graduation credits by August 2017
I already met with Leslie Abbott at Texas Workforce
I can independently care for my hygiene and grooming
I can independently care for my daily living skills such as feeding, toileting, dressing and navigating the environment
I can maintain appropriate behavior and social skills in the workplace
I can take direction from supervisors and modify my behavior
I can effectively communicate my wants and needs
I will arrange transportation to and from Baylor Scott & White Hospital
I have had previous work experience including school, volunteer or paid employment
I will be willing to take a drug test, make sure immunizations are up to date, and submit to a criminal background check
My desire is to secure paid employment at the conclusion of Project SEARCH

Project SEARCH entrance criteria:

Student must be at least 18 years of age.
Student must have completed all requirements for graduation.
Student must meet eligibility requirements for TEXAS WORKFORCE SOLUTIONS.
Student must have independent personal hygiene and grooming skills.
Student must have independent daily living skills.
Student must maintain appropriate behavior and social skills in school and workplace.
Student must take direction to change behavior.
Student must be able to communicate effectively.
Student must have the desire to work while in the Project SEARCH Internship.
Student must have the ability to pass a drug screen and background check.
Student must have immunizations up to date.
Student must have the desire to work competitively at the conclusion of the Project SEARCH program.