College Steps Application for Admission

Student Information

BACKGROUND INFORMATION
Application Type*

I am a new applicantI am reapplying
Student Name*

First NameLast Name
Preferred Name*
Preferred Student Name
Gender

MaleFemaleOther Identification
Preferred Pronouns
Date of Birth*

MonthDayYear
Student Email*
example@example.com
Student Phone Number
Format: 000-000-0000. Provide student number only.
Mailing Address*

Street Address

Street Address Line 2

CityState (Format: VT)/ Province

Zip CodeCountry
How did you initially learn out about College Steps?*
Additional Details*
Include Event/Date, online web search, Contact, etc.
Consent to Communicate*

I acknowledge College Steps can communicate with the contacts listed on my application as a means to gather or provide information relevant to my application/enrollment

Information on Parent(s)/Caregiver(s)

May include other contact for independent students
I Need to Update my Guardianship or Family Contact Information

YesNo
Guardianship

I am my own legal guardianSomeone else serves as my legal guardianI share my legal guardianship with another personOther
Additional Guardianship Information
Please Include a Parent/Caregiver in our Followup*

YesNo
Applicant lives with:*
Explain Other
Parent/Caregiver 1*

First NameLast Name
Relationship to Applicant*
Parent/Caregiver Email*
example@example.com
Parent/Caregiver Phone Number*
Format: 000-000-0000
Parent/Caregiver 2

First NameLast Name
Relationship to Applicant
Parent/Caregiver 2 Email
example@example.com
Parent/Caregiver 2 Phone Number
Format: 000-000-0000

Part C

EDUCATIONAL BACKGROUND
I Need to Update my Educational Background Information

YesNo
High School Status*

GraduatedAnticipated/High School TransitionOther
Please specify diploma type:
Date of High School Graduation or Anticipated Completion*

MonthDayYear
School District*
High School*
High School Location (City, State):*
District Contact

First NameLast Name
District Contact Email
example@example.com
District Contact Phone Number
Format: 000-000-0000
Additional District Team Members
If you currently or previously require(d) support from a PCA or one-on-one Paraprofessional, please describe the support you receive(d):

Part D

STUDENT HISTORY
Please provide your social or learning challenge diagnosis:*
Have you discontinued a program prior to completion?*
If yes, explain:
Have you had any prior psychiatric hospitalizations?*
If yes, additional documentation will be requested.
Background Check: Other than traffic offenses, have you ever been convicted of any misdemeanor, felony, or other crime?*

YesNo
Additional Details
I work with an Educational Advocate or Attorney*

YesNo
Educational Advocate/Attorney

First NameLast Name
Educational Advocate/Attorney Email
example@example.com
Educational Advocate/Attorney Phone Number
Format: 000-000-0000
I am supported by a State or Community Agency*

YesNo
Designated Agency/Community Support Agency
Case Manager/Coordinator

First NameLast Name
Case Manager/Coordinator Email
example@example.com
Case Manager/Coordinator Phone
Format: 000-000-0000
I have an additional case managers to include
Designated Agency/Community Support Agency
Case Manager/Coordinator

First NameLast Name
Case Manager/Coordinator Email
example@example.com
Case Manager/Coordinator Phone
Format: 000-000-0000

Part E

STUDENT GOALS
The submissions below are used to assist during the student's independent portion of the interview.

They must be written and submitted in the student's own words.
1. Why do you want to go to college?*
2. What are your college goals?*
3. How can College Steps help you to achieve your college goals?*
I confirm the above short answers were written in the student's own words. Note: inaccurate confirmation may result in the withdrawal of the student's application.*

Yes

File Upload

Cancelof
Part F

SUPPORTING DOCUMENTATION AND APPLICATION SUBMISSION
I Have Updated Documentation to Submit

YesNo
You will receive a follow up email with a link to upload all relevant PDF Documentation including, but not limited to:

» IEP and/or 504 » Transcripts » Evaluations to include any documentation to support prior treatments or diagnoses (e.g. Psychoeducational, Psychodiagnostic, Speech and Language, Behavior Plans, etc.)
All information submitted above is accurate and no information has been withheld. I understand that any violations to these terms may result in dismissal.*

Yes, I agree and understand.
Admissions
Group
Type
Should be Empty:

Student Information