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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 four of the following items:
___ Student Application
___ Recommendation from a High School Teacher or Administrator
___ Parent/Guardian Recommendation and Consent
___ Student's Official Grade Report/Transcript (Request Form attached)
This form is to be completed by the high school student applicant. Please attach any additional printed, typed, audio, or video taped responses labeled with the student's full name. Return forms and attachments to:
DO-IT Scholar Application
University of Washington, Box 354842
Seattle, Washington 98195-4842
Applicant Name_________________________________________________________________ Address________________________________________________________________________ _______________________________________________________________________________ Telephone (__________)_____________________ Email ____________________________ Date of Birth_______________ Sex__________ Ethnicity_________________________ High School Name_______________________________________________________________ Grade Level________________________________ Expected Date of Graduation_______ Academic and other awards (if any):____________________________________________ _______________________________________________________________________________
Respond to items 1-10 on a separate piece of paper (or on audio or video tape, if your disability affects your writing). You must respond to each question.
The DO-IT Scholars program prepares young people with disabilities for college, careers, independent living, and leadership roles in society.
The DO-IT Scholars program consists of three phases. After graduating from the third phase, Scholars become DO-IT Ambassadors. There are two main components to the DO-IT Scholars program:
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,
doit@u.washington.edu
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, counselor, or administrator. Please share pertinent information about the student and their disability. Attach additional pages as needed to address the items below. Return this form and any additional attachments to:
DO-IT Scholar Application
University of Washington, Box 354842
Seattle, Washington 98195-4842
Name of person filling out report (please print) ______________________________ Position/Title ________________________________________________________________ Signature ________________________________________ Date _______________________ Address _______________________________________________________________________ Telephone________________________________________ Email ______________________ Endorsement by School Principal _______________________________________________
Student Applicant's Name_______________________________________________________ High School Name________________________________________ District Number_______ School Address_________________________________________________________________ Grade Level, current academic year_____________________________________________ Student's Cumulative High School GPA _________ , for grades _____ through _____ What percentage of the student's time is spent in Specially Designed Instruction (SDI)?
Respond to questions on a separate piece of paper (or on audio or video tape, if needed). You must respond to each question.
The DO-IT Scholars program prepares young people with disabilities for college, careers, independent living, and leadership roles in society.
The DO-IT Scholars program consists of three phases. After graduating from the third phase, Scholars become DO-IT Ambassadors. There are two main components to the DO-IT Scholars program:
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
doit@u.washington.edu
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 by the parent or guardian of the applicant. Parents/legal guardians may submit application materials in their native language or in audio/video tape format. Attach additional pages as needed to address the items below. Return this form and any additional attachments with the complete application package to:
DO-IT Scholar Application
University of Washington, Box 354842
Seattle, Washington 98195-4842
Student applicant's name (please print) _______________________________________ Name of parent/legal guardian (please print) __________________________________ Address _______________________________________________________________________ Telephone ___________________________ Email ___________________________________ Name of additional parent/legal guardian(s) (please print) ___________________ Address________________________________________________________________________ Telephone ___________________________ Email ___________________________________ I give approval for (applicant) ______________________ to participate in the DO-IT Scholars program and I authorize the release of school documentation related to his/her disability and academic record to DO-IT. I understand that, if accepted, my child is expected to attend Summer Study (usually held the last two weeks of July). Signature_____________________________ Date ___________________________________
Respond to questions on a separate piece of paper (or on audio or video tape, if needed). You must respond to each question.
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.)
Computer ____________
Software ____________
Adaptive Technology ____________
Internet Service ____________
The DO-IT Scholars program prepares young people with disabilities for college, careers, independent living, and leadership roles in society.
The DO-IT Scholars program consists of three phases. After graduating from the third phase, Scholars become DO-IT Ambassadors. There are two main components to the DO-IT Scholars program:
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
doit@u.washington.edu
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.
Please do not send this form to DO-IT.
This optional form is a tool for Scholar applicants to request transcripts. This form is to be filled out by the parent/legal guardian of the applicant and submitted to the applicant's school.
To be considered in the first round of the selection process, transcripts and other application materials must be received at DO-IT by January 10th.
Student's name _______________________________________________________________ Home address _________________________________________________________________ Phone ________________________________________________________________________ Birth date ____________________________________________________________________ Social Security # ____________________________________________________________ Name of school ________________________________________________________________ Grade in school _______________________________________________________________ I request that official grade reports/transcripts for the past two years be sent to DO-IT (Disabilities, Opportunities, Internetworking, and Technology) at the address or fax below. I give permission for this information to be sent to DO-IT. Student signature _____________________________________________ Date __________ Parent/Guardian signature _____________________________________ Date:__________ Parent/Guardian name (print) __________________________________________________
Please send official grade reports/transcripts to:
DO-IT Scholar Application
University of Washington, Box 354842
Seattle, Washington 98195-4842
FAX 206-221-4171
For information about DO-IT, call 206-685-DOIT (3648) (voice/TTY).
DO-IT (Disabilities, Opportunities, Internetworking, and Technology) serves to increase the successful participation of individuals with disabilities in challenging academic programs such as those in science, engineering, mathematics, and technology. Primary funding for DO-IT is provided by the National Science Foundation, the State of Washington, and the U.S. Department of Education.
To order free publications or newsletters use the DO-IT Publications Order Form; to order videos and training materials use the Videos, Books and Comprehensive Training Materials Order Form.
For further information, to be placed on the DO-IT mailing list, or to request materials in an alternate format, contact:
DO-ITDirector: Sheryl Burgstahler, Ph.D.
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