The Appendices include sample documents that can be adapted for transition programs. However, inclusion in this book does not imply endorsement. Consult legal experts in your organization or community to establish guidelines and informed consent forms that deal appropriately with child safety issues. These Appendices are available online, along with the other content of this book, at Creating a Transition Program for Teens: How DO-IT does it, and how you can do it, too.
Disclaimer: This entry is part of the 2008 book, Creating a Transition Program for Teens: How DO-IT Does It, and How You Can Do It, Too. For the current application and deadlines for the Scholars Program, please visit our Scholars Application page.
You are encouraged to submit your application by January 10th. Applications received after that date will be reviewed on a space available basis.
A complete DO-IT Scholars application includes all of the following items:
______ Student Application
______ Recommendation from High School Teacher or Administrator (signed by school principal)
______ Parent/Guardian Recommendation and Consent
______ Student's grade record for the last two years (Transcript Request Form attached)
This form is to be completed by the high school student applicant. Please attach printed, typed, or taped responses. Return this form and any additional attachments to
DO-IT Scholar Application
Box 355670
University of Washington
Seattle, Washington 98195-5670
If you have questions about the Scholars program or this form, please contact DO-IT at
206-685-DOIT (3648) (voice/TTY)
888-972-DOIT (3648) (toll free voice/TTY)
206-221-4171 (fax)
509-328-9331 (voice/TTY) Spokane office
doit@u.washington.edu
Name:_______________________ Address:________________________________________
Telephone:____________________________________________________________________
High School Name:___________________________________ Grade Level:______________
Date of Birth:____/_____/_____ Gender:___________ Ethnicity:_____________________
Expected Date of Graduation:____/_____/_____ Email:_______________________ ______
Academic and Other Awards (if any):_____________________________________________
Respond to items 1–10 on a separate piece of paper (or on audio tape, if your disability affects your writing). You must respond to each item.
Signature:________________________________________ Date:____________________
All DO-IT Scholars program offerings are contingent upon receipt of continued funding. All DO-IT Scholar participants are required to be residents of Washington State.
The University of Washington ensures equal opportunity in education regardless of race, color, creed, religion, national origin, sex, sexual orientation, age, marital status, disability, disabled veteran, or Vietnam era veteran status in accordance with University policy and applicable federal and state statutes and regulations.
This form is to be filled out and returned by a teacher or administrator. Please share pertinent information about the student and his or her disability. Attach additional pages as needed to address the items below. Return this form and any additional attachments to
DO-IT Scholar Application
Box 355670
University of Washington
Seattle, Washington 98195-5670
If you have questions about the Scholars program or this form, please contact DO-IT at
206-685-DOIT (3648) (voice/TTY)
888-972-DOIT (3648) (toll free voice/TTY)
206-221-4171 (fax)
509-328-9331 (voice/TTY) Spokane office
doit@u.washington.edu
Student Applicant's Name:______________________________________________________
High School & District Names:___________________________________________________
School Address:________________________________________________________________
Grade Level, Current Academic Year:_____________________________________________
Student's Cumulative High School GPA __________, for Grades _____ Through _______
Does this student have a disability that is recognized by the school/district? __________
If so, what is the nature of the disability, and how does it affect them academically?
Please comment on this student's academic interests.
Please comment on this student's potential to complete a college program.
Please comment on how this student works in group learning environments.
Please comment on this student's computer skills.
Please comment on why you think this student is a good candidate for this program as described in the DO-IT Scholars brochure.
Additional comments (optional):
Name of person filling out report (please print): _______________________________
Position/Title: ______________________________________________________________
Signature: _______________________________ Date: _______________________________
Address: ________________________________________________________________________
Telephone: _______________________________ Email: _______________________________
Endorsement by School Principal: _________________________________________________
All DO-IT Scholars program offerings are contingent upon receipt of continued funding. All DO-IT Scholar participants are required to be residents of Washington State.
The University of Washington ensures equal opportunity in education regardless of race, color, creed, religion, national origin, sex, sexual orientation, age, marital status, disability, disabled veteran, or Vietnam era veteran status in accordance with University policy and applicable federal and state statutes and regulations.
This form is to be filled out and returned by the parent or guardian of the applicant. Attach additional pages as needed to address the items below. Return this form and any additional attachments to
DO-IT Scholar Application
Box 355670
University of Washington
Seattle, Washington 98195-5670
If you have questions about the DO-IT Scholars program or this form, please contact DO-IT at
206-685-DOIT (3648) (voice/TTY)
888-972-DOIT (3648) (toll free voice/TTY)
206-221-4171 (fax)
509-328-9331 (voice/TTY) Spokane office
Student Applicant's Name (please print):_______________________________________
Please comment on the interest that the applicant has shown in attending a college or university after high school graduation.
In what areas has the applicant shown academic or career interests?
Why is the applicant a good candidate for this program?
Provide additional comments or information regarding the applicant that would be useful to DO-IT program staff.
If you have a computer at home, please indicate:
Platform ____________________ (e.g., Mac/PC)
Model __________________ (Model name is written on the CPU box, e.g., Apple G2)
CPU ____________________ (e.g., Pentium, Power PC, etc.)
If the applicant requires a loan of equipment to use at home during this project, please check the needed equipment below:
Computer _________________________________________________________________
Software _________________________________________________________________
Adaptive Technology ______________________________________________________
Internet Service _________________________________________________________
Name of parent/legal guardian (please print): _________________________________
Address: ______________________________________________________________________
Telephone: _________________________________ Email: ___________________________
I give approval for (applicant) ____________________ to participate in the DO-IT Scholars program, and I authorize the release to DO-IT of school documentation related to his/her disability and academic record. I understand that, if accepted, my child is expected to attend Summer Study (usually held the first two weeks of August) and communicate with program participants year-round on the Internet.
Signature: ____________________________ Date:_______________________
All DO-IT Scholars program offerings are contingent upon receipt of continued funding. All DO-IT Scholar participants are required to be residents of Washington State.
The University of Washington ensures equal opportunity in education regardless of race, color, creed, religion, national origin, sex, sexual orientation, age, marital status, disability, disabled veteran, or Vietnam era veteran status in accordance with University policy and applicable federal and state statutes and regulation.
DO-IT Scholar Applicant: This form is an optional tool for you to request that transcripts from your school be sent to the DO-IT Center as part of your Scholar application. It can be filled out by you and a parent/legal guardian and submitted to your school. Note:
To be considered in the first round of the selection process, transcripts and other application materials must be received at the DO-IT Center by January 10.
Name of Student: _____________________________________________________________
Home Address: ________________________________________________________________
Telephone: ___________________________________________________________________
Birth Date: __________________________________________________________________
Grade in School: _____________________________________________________________
Social Security Number: _______-_____-_______
Name of School: ______________________________________________________________
I request that official grade reports/transcripts for the past two years be sent to DO-IT (Disabilities, Opportunities, Internetworking, and Technology) at DO-IT Scholar Application
Box 355670
University of Washington
Seattle, Washington 98195-5670
206-221-4171 (fax)
I give permission for this information to be sent to the DO-IT center.
Signature of Participant: _____________________________________ Date: __________
Signature of Parent/Guardian: _____________________________________ Date: ______
Name of Parent/Guardian (print): _______________________________________________
For information about DO-IT, call 206-685-DOIT (3648) (voice/TTY), send email to doit@u.washington.edu, or consult www.washington.edu/doit.
Name of Participant:__________________________ Disability:______________________
Please describe how your disability affects your ability to do your schoolwork (in class and outside of class).
Do you use any of the following tools?
__ taped texts
__ interpreter
__ FM hearing system
__ note taker/scribe
__ wheelchair
__ Braille
__ large-print materials
__ personal attendant
__ guide dog
__ walking device
__ other (please describe):_____________________________________________________________________________________________
Which math course will you have completed by June 2005?
__ algebra
__ geometry
__ trigonometry
__ precalculus
__ calculus
Which science classes will you have completed by June 2005?
__ biology
__ chemistry
__ physics
__ geology
__ health
__ psychology
__ anatomy
__ earth science
__ other (please describe): ____________________________________________________________________________
Which computer classes will you have completed by June 2005?
__ HTML/web design
__ keyboarding
__ programming
__ computer aided drafting
__ other (please describe):___________________________________________________________________________________________________
Which computer software have you used?
__ Microsoft Word
__ WordPerfect
__ Microsoft Excel
__ Adobe PageMaker
__ Microsoft Windows
__ other (please describe):____________________________________________________________________________________________________________
Do you have experience using the Internet?
__ Web browser
__ FTP
__ email
__ HTML
__ other (please describe):_____________________________________________________________________________________________________________________________________________________________________________________________________________
Most DO-IT activities will take place on campus or in the adjoining community. Locations include McCarty Hall, the Burke Museum, engineering and science labs, and Husky Union Building. The DO-IT Summer Study Program participants will also take three off-campus field trips, tentatively scheduled as:
Friday, August 6 Microsoft Tour
Saturday, August 7 Pacific Science Center
Sunday, August 8 Seattle Aquarium
For these events, students will travel on a bus with DO-IT staff. They will be returned to McCarty Hall at University of Washington.
I give my consent for ______________________________ (Name of Student) to attend all DO-IT Summer Study activities, including field trips. I understand that most of the scheduled DO-IT activities will take place on campus or in the adjoining community. I understand that there will also be three off-campus field trips for which supervision and bus transportation will be provided.
Signature of Parent/Guardian: _______________________________________ Date: ______________________
Printed Name of Parent/Guardian: _______________________________________ Date: ______________________
Members of the news media (print, broadcast, and electronic) often express an interest in covering DO-IT programs. News people may film, tape record, or photograph various activities. If participants object to being included in news coverage in any way, they should simply tell the reporter that they do not wish to be included.
If a reporter or other member of the news media asks us for information about you, we will provide them with a copy of this form. Please fill in the information, if any, you would like to share with a reporter.
Name of DO-IT Scholar: _______________________________________________________
Hometown: _________________________________________________________________
School: _______________________________ Year in School: ________________________
Disability:___________________________________________________________________
Phone Number(s):____________________________________________________________
E-mail Address(es):___________________________________________________________
Other Comments: ____________________________________________________________
Signature of DO-IT Scholar: _____________________________________________ Date: ______________________
I ___________________________________________ (Name of Parent/Guardian) hereby certify that I am the parent or guardian of _________________________________________________________ (Name of Participant).
I hereby consent to his/her wishes as set forth in the release herein above.
Signature of Parent/Guardian: _____________________________________________ Date: ______________________
General Office Assistance: Volunteers assist with collating, labeling, and assembling resource packets for many mailings, resource production projects, and preparation for conferences.
Data Entry: Volunteers with basic data entry skills update our various program participant and contact databases.
Conference Booth Assistance: DO-IT frequently hosts exhibits at conferences, job fairs, or special events. Volunteers share information about DO-IT programs and distribute resource material.
Transportation: Occasionally volunteers provide transportation for adults with disabilities making presentations or attending special events.
Field Trip Escort: On a field trip to an industry tour, a visit to a college, or a trip to participate in a job fair, volunteers assist students with disabilities by providing accommodations, reading information, or assisting as chaperones.
Workshop/Classroom Presentations: DO-IT conducts various college and career exploration classes in which volunteers assist one-to-one with assignments and provide accommodations to students with disabilities.
Computer Setup/Support: Volunteers with good technical skills assist in setting up computer labs or demonstration displays. During events, these volunteers provide technical support and assist users in learning about the adaptive technology.
Our calendar includes events or activities throughout the year. Many of our volunteer needs are periodic. DO-IT Summer Study, our intensive two-week camp, is held late July to early August. Many DO-IT events, such as the yearly Summer Study and field trips, are photographed and/or videotaped. If you choose to attend any of these events, you may be asked to complete a publications release form.
Please complete the DO-IT Volunteer Application to indicate your skills, availability, and contact information. All volunteer candidates will also be asked to complete and return the UW Conviction/Criminal History Information form, which will be mailed to you once we receive your completed application. This position requires successful completion of a criminal history background check.
Thank you for your interest in supporting DO-IT!
Name:________________________________________________________________________
Telephone (day):________________________ Email: ________________________________
Mailing Address:_______________________________________________________________ ______________________________________________________________________________
I am interested in the following volunteer opportunities:
_____General Office Assistance
_____Data Entry
_____Conference Booth Assistance
_____Transportation
_____Field Trip Escort
_____Workshop/Classroom Presentation
_____Computer Setup/Support
_____Other ________________________________________________
Availability:
_____Weekdays, during regular business hours
_____Weekday evenings
_____Weekends
_____Other:________________________________________
Frequency:
_____Occasional, please call as needed
_____Ongoing, regular schedule: _____ Daily _____ Weekly
_____Other:________________________________________
List other specific skills or interests that relate to your volunteer interest:
______________________________________________________________________________
______________________________________________________________________________
List two references (please include name and contact phone or email):
______________________________________________________________________________
______________________________________________________________________________
Please return the completed application to DO-IT, University of Washington, Box 355670, Seattle, WA 98195-5670; email to doit@u.washington.edu or fax to 206-221-4171.
I, ______________________________________________________________________ (First and Last Name of Participant), hereby give DO-IT (Disabilities, Opportunities, Internetworking, and Technology) and DO-IT project partners the right and permission to copyright, distribute, sell, broadcast, duplicate, exhibit, and/or use film, audiotape, photographs, printed information, and/or drawings of me without limitation for general education, information dissemination, and research purposes in videotapes, audiotapes, and printed publications and on the World Wide Web. I give DO-IT permission to publish information including, but not limited to, my first and last name, email address, city and state of residence, name of school, disability, age, and interests.
I hereby waive any right to inspect or approve the finished publication or the eventual use for which it might be applied.
Signature of Participant: __________________________________________ Date: __________________
For participants under 18 years of age, please have a parent/guardian complete the following:
I hereby certify that I am the parent or guardian of __________________________________________ (Name of Participant)
I agree to the statements above.
Printed Name of Parent/Guardian: __________________________________________
Signature of Parent/Guardian: __________________________________________ Date: __________________
The DO-IT (Disabilities, Opportunities, Internetworking, and Technology) electronic mentoring community provides an opportunity for students with disabilities to communicate via electronic mail and during program activities with Mentors and other students with disabilities. Your role as a DO-IT Mentor is a mix of friend and teacher. Your goal is to inspire and facilitate personal, academic, and career achievements in the DO-IT participants for whom you mentor. These protégés are college-capable students with disabilities pursuing challenging academic and career fields.
The relationships you develop with your protégés become channels for the passage of information, advice, challenges, opportunities, and support. DO-IT Mentors offer protégés the following:
DO-IT Mentors are college students, postsecondary faculty, and professionals in a variety of challenging academic and career fields. Many of the Mentors have disabilities themselves. The Mentors support high school and college students with disabilities as they transition to college and careers.
Mentors and protégés communicate primarily through the use of electronic mail. Email eliminates the challenges imposed by time, distance, and disability that are characteristic of in-person mentoring. Frequent email communication, combined with personal contact at DO-IT sponsored events, facilitates personal, academic, and career achievement.
DO-IT Mentors are subscribed to several electronic discussion lists. These lists include
For more information about DO-IT's mentoring community, consult Opening Doors: Mentoring on the Internet at www.washington.edu/doit/opening-doors-mentoring-internet.
As part of a special project, DO-IT is inviting Mentors with academic and/or professional backgrounds in science, technology, engineering, and mathematics (STEM) fields to participate in AccessSTEM mentoring teams. This effort is part of DO-IT's Northwest Alliance for Access to Science, Technology, Engineering, and Mathematics, funded by the National Science Foundation (Cooperative Agreement #HRD-0227995). Each mentoring team links students together with Mentors who are studying, teaching, and working in a STEM area similar to those the protégé is interested in pursuing. Ideally, each AccessSTEM mentoring team is composed of at least one high school student, one college student, and one STEM professional. These Mentors participate on the AccessSTEM, mentors, and doitsem discussion lists; they have the option of joining doitchat and disability-specific lists.
As a DO-IT Mentor, you must have access to email and the Internet. To apply to be a DO-IT Mentor, complete the attached application.
Because safety is of particular concern for young people using the Internet, this position requires successful completion of a criminal history background check. All Mentor candidates are asked to complete and return the University of Washington Conviction/Criminal History Information form. This form will be mailed to you once we receive your completed application.
Complete the form below, attaching additional pages if necessary.
Name: ____________________________ Postal Address: __________________________
____________________________________________________________________________
Home Telephone: ___________________ Email: __________________________________
References: Please list names and contact information for three references.
Please note that, on occasion, DO-IT Mentors are featured in DO-IT printed and web-based materials such as DO-IT NEWS and in other publications. As a DO-IT Mentor, you agree to allow DO-IT and DO-IT project partners to publish information including, but not limited to, your first and last name, email address, city and state of residence, name of school, employer, disability, age, and interests. This information is used for program reporting and data analysis. As a DO-IT Mentor, you also waive any right to inspect or approve the finished publication or the eventual use for which it might be applied.
(Optional) Permission to use Photographs and Video: Many DO-IT events, such as the yearly mentoring luncheon, are photographed and/or videotaped. If you attend any of these events, you may be photographed and/or videotaped. Sign below if you give DO-IT and DO-IT project partners permission to copyright, distribute, sell, broadcast, duplicate, exhibit and/or use film, audiotape, photographs, printed information, and/or drawings of yourself without limitation for general education, information dissemination, and research purposes in videotapes, DVDs, audiotapes, online streaming videos, and printed publications, and on the Web. You waive any right to inspect or approve the finished publication or other product in which your image/information might be used.
Signature: ________________________________ Date: ________________________
I have read and agree to the expectations listed for DO-IT Mentors as indicated above. I authorize DO-IT to contact my references and process a background check.
Signature: ________________________________ Date: ________________________
For questions 3–9, choose the response that best describes your interactions with DO-IT Scholars or DO-IT Mentors and/or staff.
For questions 10–13, choose the response that best matches your feelings about each statement. Choose "Not applicable" if the statement does not apply to your situation.
Thank you for your participation.
For items 1 through 6, please choose the letter of the response that best describes your answer.
For items 7 through 19, please choose the letter of the response that best matches your feelings about the statements.
Thanks for making Summer Study a success! The following guidelines will help you move smoothly through the Summer Study program and gain the maximum benefit from the activities. This schedule lets you know what is planned and when to be ready!
Academic/College Preparation
Planning for college, securing accommodations, exploring different fields of study.
Career Preparation
Exploring new and exciting career fields, participating in work-based learning, creating a resume.
High-Tech Skills
Developing technology skills, learning about assistive technology, designing a website.
Here are a few helpful tips to guide you, as a personal assistant, through the Summer Study experience.
Families for whom the cost of a personal care assistant salary would impede a Scholar from attending the Summer Study program may apply for a scholarship of up to $350 per week. DO-IT Scholars and their parents/guardians are responsible for hiring adult (over the age of eighteen years) personal care assistants and paying their salaries. DO-IT pays for room and board for personal care assistants who work for Scholars during the Summer Study program. Parents of Scholars are not eligible to be paid as personal care assistants through this scholarship. A parent/guardian or adult Scholar must complete and return the form below to apply for need-based scholarship for the salary of a personal care assistant.
Sheryl Burgstahler
Director, DO-IT (Disabilities, Opportunities, Internetworking, Technology)
Box 355670, University of Washington
Seattle, Washington 98195-5670
Name of DO-IT Scholar:_____________________ Telephone: ________________________
Name, Social Security Number, and Resident Status of person responsible for covering cost of personal care assistance (parent/guardian or adult Scholar who will use the funds to pay the salary of the personal care assistant)—The check will be made payable to this person:
Name: ____________________________ Social Security Number: __________________
Resident Status (choose one): U.S. Citizen/Nonresident Alien/Resident Alien
I request that $___________ total (up to $350/week) be provided for the salary of a personal care assistant during the DO-IT Summer Study program. I have not accepted and do not plan to accept other funding for this portion of personal care assistant costs, and I will notify DO-IT immediately if other funding becomes available.
I intend to pay ______________________(name of personal care assistant) for personal care assistance during the DO-IT Summer Study program. I understand that the check will be mailed to me after the conclusion of the Summer Study program and it is my responsibility to use these funds exclusively to pay the salary of the assistant for the Scholar named above.
Signature of DO-IT Scholar:_________________________ Date:__________________
Signature of Parent/Guardian, if the DO-IT Scholar is under the age of eighteen: __________________________________________________ Date__________________
Emergency (e.g., major health concern or injury, threatening/violent behavior)
Minor Incident Procedures (e.g., health concern, minor injury, behavior concern)
Group Meeting Locations (e.g., upon evacuation due to fire, earthquake, or other emergency)
ALL staff should assist to verify that everyone is accounted for as soon as possible.
Name of DO-IT Scholar:______________________ Phase:____________________
Telephone:___________________________________
Disability: ___________________________________________________________________
Date of Birth:______________________ Career Goal:______________________________
Favorite Classes: #1____________________________ #2 ___________________________
Name of Parent/Guardian:____________________________________________________
Email of Parent/Guardian:_______________________Add to Parent Email List? yes/no
Summer Study Phase I: Tuesday, July 26–Friday, August 5
Registration—3–5 pm Tuesday, July 26
Pick-up time—4–6 pm Friday, August 5
Summer Study Phase II: Saturday, July 30–Friday, August 5
Registration—3–5 pm Saturday, July 30
Pick-up time—4–6 pm Friday, August 5
How will you be getting to Seattle?
Do you need assistance getting to the University of Washington? If you are looking for financial assistance to fund your travel, have you contacted local organizations, schools, community organizations (fund-raisers), businesses, or family members? We are able to pick up Scholars at the train station or airport; however, it is expected that Scholar families will cover other costs of travel to and from the UW. Need-based travel scholarships are available.
Who will be traveling with you?
Have you determined your travel dates and times yet?
Note: Rooms are available for those traveling a distance needing to come on Friday, July 29, or leave on Saturday, August 6. Dorms will not be staffed by DO-IT after 11:00 am on August 6.
Parking will be reimbursed for parents or family members who drop their children at the UW. Details about parking will be described in the next Scholar letter.
Many Scholars will require some type of accommodation in order to participate in class and evening activities.
Academic activities are generally scheduled 9:00-5:00; nonacademic activities are generally scheduled 7:00-9:00 pm with some kind of wind-down option available to the late-nighters between 9:00 and 11:00 pm.
What is helpful to you in a classroom setting?
Do you use
To actively participate, for what activities do you need an interpreter?
In what format would you like to have the following materials?
If you use large print when reading written materials,
What is your seating preference?
What additional accommodations might you need during Summer Study?
Will you need transportation to go across campus (more than a quarter mile)?
Will you be bringing a wheelchair? If so, is it
Is the wheelbase wider than thirty inches? (We advise that Scholars bring a manual backup if they have one, in case of mechanical breakdown or battery problems).
Do you need to use the wheelchair at all times?
Typically, breakfast runs from 7:30-8:30 am. Classes start at 9:00. Given this information, Scholars need to think about what time they need to get up and how long it will take them to get ready in the morning. DO-IT staff members do not provide personal care assistance unless it is very minor.
Some Scholars need plenty of rest, so we try to match roommates' sleep needs; however, we are not always successful, so we ask Scholars to communicate and respect each other's needs and preferences of their roommates.
What is your normal summer sleep schedule?
Do you need assistance with personal care? Be specific regarding the type of assistance needed:
Will you need a personal care assistant to help you with personal care tasks in the morning, evening, or throughout the day? If so,
Would you like a hospital bed (moves up/down/various positions)? Note that a standard bed has railings.
Tell me anything else we should know about your personal care needs.
The dorm rooms do not have bathrooms in them. Bathrooms are community bathrooms across the hall from the rooms with communal sinks and individual toilet and shower stalls. The dorms put raised toilet seats in one wheelchair-accessible toilet stall on each floor. Flexible shower handles are usually available in one stall. The doors to the rooms are wide enough to accommodate a standard manual or motorized wheelchair in most cases. Scholars may need a roll-in shower or a transfer bench.
Do you shower or use a bathtub? Alone or with help? Will your helper be male or female?
How long does it take you?
What time of day do you usually shower/bathe?
How often?
Do you use a shower chair? If so, describe style. Flexible shower head/hose? Hoyer lift? What will you be bringing with you?
Will your personal care assistant be bringing a vehicle? If so, we will provide a parking pass for them for the dates they are here. Do you need a wheelchair accessible parking space or just a disability space? Do you have an oversized vehicle?
DO-IT does not have a doctor or nurse on staff. We are unable to administer medications to Scholars. If Scholars need assistance with medications, we urge them to come with someone who can help them. We urge Scholars and their families to devise independent ways to remember and administer medications if they are necessary—alarms, dated pill cases, calendar, etc. If someone needs shots administered, is not coming with a personal care assistant, and cannot administer the shots themselves, we need to know this so we can explore making arrangements with health care providers at Hall Health Medical Center or the UW hospital.
The schedule is packed with activities for Scholars to participate in from morning to evening. However, it is intentionally modular so that those who need rest periods will be able to jump back in at any time. We ask that Scholars monitor their own health and activity levels and excuse themselves if they need to rest, informing DO-IT staff on duty at the time of their need to rest.
Is it necessary for you to have time during the day to rest, do therapy, or attend to personal care needs? What time usually and how long?
Is there anything else we should know about medications or health issues?
Meals are eaten as a group. Each Scholar will get a meal card to cover costs of meals for themselves and personal assistants. Breakfast is generally 7:30-9:00 am, lunch is 12:30-1:30 pm, and dinner is 5:30-7:00 pm. Lunch is typically food-court style in the Husky Den, with a wide array of choices. Breakfast and dinners are served cafeteria/food-court style in McMahon Hall, with a selection of main entrees, salads, beverages, and desserts. DO-IT also provides snacks (juice, soda, water, fruit, sweet or salty snack foods) during two half-hour snack breaks (10:30-11:00 am and 3:30-4:00 pm) and in the evening.
Do you have any dietary considerations that if not met during the two weeks of Summer Study would be harmful to your health? Is your diet typically
vegetarian? vegan? low salt? low-fat? other?
Generally each food service area can accommodate these needs. Refrigerators can be made available in a dorm room if a Scholar needs to refrigerate medication or special dietary items.
Do you eat independently or with help? Do you need adaptive equipment during meal-time? (If yes, please be sure to bring and label it.)
Do you require a straw for drinking beverages?
Is there anything else we should know about your diet or eating issues?
Attendance at a religious service is an option for Scholars. We try to match Scholars to a service but may not always be successful. Would you like to attend a service? If so,
Do you have family or friends that you would go with, or would you like DO-IT to try to find a volunteer to go with you?
Phase I only: What is a fun fact about you that can be used for an icebreaker activity on the first night of Summer Study?
Phase II only: What is your progress on your
Phase II project?
Should an emergency arise, DO-IT Summer Study staff will contact parents immediately. However, should we be unable to reach you, we would like the name and phone number of an alternative contact person and your child's physician.
Please complete the following:
Name of Scholar:______________________ Name of Parent/Guardian:_______________
Home Phone(s):_______________________ Work Phone(s):_________________________
Alternative Contact Name(s): __________________________________________________
Home Phone(s):_______________________ Work Phone(s):_________________________
Name of Physician(s): _________________________________________________________
Phone(s): ____________________________________________________________________
Please describe below any pertinent medical conditions, allergies, considerations, or situations that may require special attention, and include a list of medications that are prescribed for this student. Also indicate other dietary restrictions, special accommodations, or general concerns of which we should be aware. If you need additional space, please attach a separate sheet.
DO-IT staff cannot take responsibility for personal care. The participant's family must provide a personal care assistant if the participant needs assistance with:
Will your child require a personal care assistant during the Summer Study program?
Yes__ No __ If yes, please provide the following information about this assistant:
Name: ____________________________________ Telephone: _______________________
Address: ____________________________________________________________________
DO-IT Scholars are capable and motivated high school students who are preparing for college. They are participants in project DO-IT (Disabilities, Opportunities, Internetworking, and Technology), which is directed by the University of Washington (UW). A wide range of disabilities are represented in each group of Scholars, including blindness, low vision, hearing impairments, mobility impairments, health impairments, attention deficit disorder, specific learning disabilities, and psychiatric disabilities.
Instructors and other volunteers are important members of the DO-IT team while Scholars participate in Summer Study programs on the University of Washington campus. Most have little, if any, previous experience working with students who have disabilities. This publication includes basic communication, lecture, discussion, field trip, and laboratory suggestions. Following these guidelines helps maximize Scholar participation and independence.
Day [number], [date]
Thank you for your participation.
_____One-time only lecture
_____One-time only lab
_____Multiple-day lab
_____Multiple-day project
_____Multiple-day lecture
_____Other; please describe: ______________________________________________
_____DO-IT handout(s)
_____DO-IT video(s)
_____Meeting/presentation by DO-IT staff
_____Conversation with DO-IT staff
_____Other; please explain: _______________________________________________
_____Yes _____No
If yes, please describe any differences in your experiences delivering the presentation to each group.
Comments:
If yes, which one(s) and why?
If no, what would have helped?
___ Yes ___ No
Please use the space below to suggest topics and presenters to include in future DO-IT summer programs and suggest ways to improve the program overall.
Thank you for your participation.
Name: __________________________________________ Date:____________________
Gender: _____________ Age: ____________
Racial/Ethnic Identification (check all that apply):
Permanent Mailing Address: ______________________________________________
_________________________________________________________________________
_________________________________________________________________________
Email: _________________________ Phone: ___________________
School Attending: ___________________
Current Grade or Year in School: ____________ Expected Graduation Year: _______________
Describe academic area(s) of study you are pursuing or interested in pursuing (e.g., major).
Describe career(s) you are interested in pursuing.
List any paid or unpaid work experience(s) you have had.
Employment Status:
If employed, name company: ____________________ Position: ________________________
Your Disabilities: _______________________________ Age of Onset: ____________________
Indicate in which of the following areas you would like assistance.
Name:________________ Grade/Year in School:________________
Work Experience:____ Location:________________
Dates of Experience:________________
Dear DO-IT Participant,
You recently participated in a work-based learning experience. In order for us to evaluate the value of this experience in your career preparation, we would like to ask you to complete the following survey and return it to [name], within one week, at [email address].
Participation is voluntary and will not affect your status in the DO-IT program. The information collected in this survey will be used to improve the support provided to students with disabilities as they pursue work-based learning experiences and to communicate the impact of this DO-IT project to others. Results of this study may be published in reports to funding sources or in other program publications. No personal identifying information will be published. When we receive your response, any identifying information will be removed (e.g. your name, email address, name of employer, etc.). The collected information will be reported in a compiled, nonidentifiable format. We may quote responses to the final question on the survey, but only in a format that does not reveal your identity. Feel free to leave a question blank if you do not wish to respond.
Please remember that sending electronic mail is similar to sending a postcard: although unlikely, it may be possible for others to view the contents of your message. Contact [name] at [phone number] with any questions you may have about this survey.
Thank you for your help.
Help us know what you have learned as a result of this work experience. Please indicate your response to these statements where 1= strongly disagree, 5 = strongly agree. Mark N/A = not applicable if the item was not addressed in your work experience (for example, if your experience did not involve working with coworkers circle, N/A (Not Applicable) for item 4).
As a result of this experience,
Not Applicable Strongly Disagree Strongly Agree
Please answer the following questions.
The purpose of this survey is to determine how DO-IT activities have impacted your son or daughter. Participation is voluntary and will not affect his/her status in DO-IT. Please omit your name. If you have questions, contact [name], [phone].
Not at All | A Small Amount | A Fair Amount | A Good Amount | A Great Deal | Not Applicable | |
---|---|---|---|---|---|---|
Participation in DO-IT has enhanced my child's: | ||||||
level of independence | 1 | 2 | 3 | 4 | 5 | n/a |
scholastic interest and participation | 1 | 2 | 3 | 4 | 5 | n/a |
interest in science, math, engineering | 1 | 2 | 3 | 4 | 5 | n/a |
interest in college | 1 | 2 | 3 | 4 | 5 | n/a |
perception of career options | 1 | 2 | 3 | 4 | 5 | n/a |
self-esteem | 1 | 2 | 3 | 4 | 5 | n/a |
social skills | 1 | 2 | 3 | 4 | 5 | n/a |
self-advocacy skills | 1 | 2 | 3 | 4 | 5 | n/a |
Not Valuable | Fairly Valuable | Valuable | Very Valuable | Extremely Valuable | Not Applicable | |
---|---|---|---|---|---|---|
Computer/Internet activities helped them develop: | ||||||
social skills | 1 | 2 | 3 | 4 | 5 | n/a |
academic skills | 1 | 2 | 3 | 4 | 5 | n/a |
career/employment skills | 1 | 2 | 3 | 4 | 5 | n/a |
Summer Study at UW helped them develop: | ||||||
social skills | 1 | 2 | 3 | 4 | 5 | n/a |
academic skills | 1 | 2 | 3 | 4 | 5 | n/a |
career/employment skills | 1 | 2 | 3 | 4 | 5 | n/a |
What is the most noticeable impact of DO-IT activities on your son or daughter?
What other activities do you recommend that DO-IT undertake (e.g., parent support group, junior high outreach)?
Additional comments:
Thank you for your participation.