Project SEARCH®

New Student Application Packet

2018-2019

At City of Rochester

Application Purpose & Guidelines

The purpose of this application packet is to outline the skill set of the Project SEARCH® student candidate. This application then enables the Selection Committee* to properly assess each student candidate’s skills, abilities and background. A parent, student, counselor, teacher or employer may be contacted by the Selection Committee to gather additional information. Our final 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:

  1. Recruitment is typically held in the spring of each year. However, there may be exceptions for entrance throughout the school year. To ensure proper assessment, all students must complete this packet of information and participate in an interview to be considered for participation in the Project SEARCH® program.
  1. All students are encouraged to attend an informational meetingand visit the host business site to learn about possible rotations and meet the instructor, job coaches and host business liaison prior to being selected to participate in Project SEARCH®.
  1. If selected, the Project SEARCH® teamwill match the student skill set and interest with the work experiences which will maximize job skill building and the opportunity for competitive employment.

* The Project SEARCH®at the City of Rochester selection committee consists of representatives from the following organizations and agencies:

  • The City of Rochester
  • RochesterCitySchool District
  • The Arc of Monroe
  • ACCES-VR
  • OPWDD
  • Strong Center for Developmental Disabilities at the University of Rochester

By completing and signing this application, the applicant and family hereby provide consent for these agencies to share student information during the application process, including status of eligibility with ACCES-VR and OPWDD.If accepted into Project SEARCH®, these partners are hereby given consent to continue to share information regarding student progress throughout participation in Project SEARCH® and beyond into competitive and/or supported employment.

Application

The following information is to be completed by the student, parents/guardians,
and teachers collaboratively:

Candidate Name: / Today’s Date:
Candidate Address: / DOB:
Email Address: / Cell
Phone:
Current School Program:
Father/Guardian / Home Phone:
Email Address: / Work Phone:
Mother/ Guardian / Home Phone:
Email Address: / Work Phone:
ACCES-VR Status: / Do you have an open
ACCES-VR case?
____Yes ____No / If yes: / Counselor Name:
Email address:
Work phone:
OPWDD Status: / Have you applied for
OPWDD services?
____Yes ____No
Have you been approved for OPWDD services?
____Yes ____No / If yes: / Service Coordinator:
Agency:
Medicaid Status: / Do you receive Medicaid?
____Yes ____No / If yes: / Contact:
SSI/SSDI Status: / Are you receiving SSI or SSDI benefits?
____ Yes ____No / If yes: / Contact:
Are you your own guardian? ____ Yes ____No

Application ~ continued

VOCATIONAL/EDUCATIONAL TRAINING:

Have you taken any career/technical education courses?

Yes / No

If yes, which course was taken, and did you complete the course?

INDEPENDENT LIVING:

Medications/ dosage/ Time of day taken by student

Medication / Dosage / Time of day / Self-Administered

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

Please list any limitations that impact employment:

Please describe your current means of transportation:

Application ~ continued

BEHAVIORAL SUMMARY:

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

Yes / No

Please Explain:

Are you able to get along with peers and adults on a work site?

Yes / No

Please Explain:

Have you ever been convicted of a crime?

Yes / No

Please Explain:

REFERENCES

Please include 2 references we can contact:

Name / Phone Number / Email

Application ~ continued

STUDENT RESPONSE QUESTIONS

(Student must respond with at least 4-5 sentences in answering these questions.)

What do you know about Project SEARCH®? (Complete in your own words)

Do you want to work in the community? Why? (Complete in your own words)

This application has been completed by:

______

Name, relationship to student (self, parent, teacher)Date

______

Student SignatureDate

Student Pre-Contract

Read the student pre-contract below and sign and date.

I, ______, understand that by signing this pre-contract I am indicating my interest in being considered for acceptance into the Project SEARCH® program. If I am selected, I agree to abide by the following terms and conditions:

  • I will complete up to three unpaid job rotations within the host business.
  • I will attend the program every day, Monday through Friday, during regular program hours and maintain a minimum of 95% attendance to maintain my spot in Project SEARCH®.
  • I understand that the Project SEARCH® program correlates with the Rochester City School District Calendar.
  • I will dress appropriately and wear required attire.
  • I will call my instructor and departmental supervisors when I am absent or tardy.
  • I will make up any instructional work missed due to program absences.
  • I understand that I am responsible for transportation to the host site.
  • I will participate in a travel training assessment, and will learn to use public transportation if appropriate.
  • I will follow all the rules established by the program and host business.
  • I will take direction from the Project SEARCH® teachers and job coaches, as well as the supervisors and coworkers on internship sites, and be willing to accept feedback and develop appropriate workplace behaviors.
  • I will attend scheduled meetings with my support team, parents, teachers, and business staff.
  • I will follow appropriate expectations as communicated by the departments that oversee my internships.
  • I will be an active participant and communicate any issues to my support team.
  • I will actively pursue employment upon completion of Project SEARCH®.
  • I will work towards independence in the community.
  • I will follow the City of Rochester and Rochester City School District Codes of Conduct.
  • I allow the partners of Project SEARCH® at the City of Rochester to share information regarding my progress in the program.

I have read the above terms and conditions and agree to abide by them if I am selected to participate in the Project SEARCH® program. I understand that I may be asked to leave Project SEARCH® if I fail to follow these terms and conditions.

______

Student Signature Date

______

Parent/Guardian Signature Date