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University of Washington

DO-IT Scholars Program Application

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DO-IT Scholar applicants must be residents of Washington State, have a disability, and be enrolled in their sophomore or junior year at high school. Individuals are encouraged to submit an 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
___ Parent/Guardian Recommendation and Consent
___ High School Teacher, Administrator, or Counselor Recommendation
___ Copy of Student's Current High School Grade Report/Transcript
___ Completed Grade Report/Transcript for DO-IT Scholar Applicant Form

Student Application
DO-IT Scholars Program

Instructions: The student applicant must complete the form below and the ten essay questions. The application materials may be submitted in your native language and in audio or video format. Attach additional pages as needed to address the items below. Return your complete Scholar application packet via mail to DO-IT Scholars application, DO-IT Center, University of Washington, Box 354842, Seattle, Washington 98195-4842.

Deadline: January 10th. For students to be ensured that they will be considered in the selection process, application materials must be received by the DO-IT Center by January 10th. Applications received after January 10th will be reviewed on a space available basis. 

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)_____________________________________________

_______________________________________________________________________________

Signature___________________________________  Date_____________________________

Respond to items 1-10 on a separate piece of paper (or in audio or video format, if your disability affects your ability to respond in printed form.

  1. Describe your interest in your two favorite academic areas (for example, science, math).
  2. Describe your education and career goals.
  3. Describe how you feel about meeting and corresponding with other high school students who have a variety of disabilities and are interested in going to college.
  4. Describe the nature of your disability and how it affects your learning or school participation.
  5. Describe the accommodations (including personal assistant) you use at school.
  6. Describe your computer and Internet experiences (if any).
  7. If you use a computer, describe any special software or hardware you use and what products you find most useful.
  8. State in 100 words or less why you would like to be included in the DO-IT Scholars program.
  9. If you received assistance from another person or used another accommodation to complete this form, please describe fully the type of assistance you received (e.g., dictated answers to someone, etc.).
  10. Additional comments (optional).

About the DO-IT Scholars Program

The DO-IT Scholars multi-year program prepares young people with disabilities for college, careers, independent living, and leadership roles in society. It consists of three phases and after graduating from high school, the opportunity to be a DO-IT Ambassador. Key aspects of the DO-IT Scholars program include:

If you have questions about the Scholars program or this form, please contact DO-IT at:

888-972-DOIT (3648) (toll free voice/TTY)
doit@uw.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 reaffirms its policy of equal opportunity regardless of race, color, creed, religion, national origin, sex, sexual orientation, age, marital status, disability, or status as a disabled veteran, or Vietnam era veteran in accordance with University policy and applicable federal and state statutes and regulations.

Parent/Guardian Recommendation and Consent
DO-IT Scholars Program

Instructions: A parent or guardian must complete the form below and six essay questions. The application materials may be submitted in your native language and audio or video format. Attach additional pages as needed to address the items below.

Return this form and attachments to the student applicant or to the DO-IT Center via

FAX: 206-221-4171
Mail: DO-IT Scholars Application, DO-IT Center, University of Washington, Box 354842, Seattle, Washington 98195-4842

Deadline: January 10th. For students to be considered in the selection process, application materials must be received by the DO-IT Center by January 10th. Applications received after January 10th will be reviewed on a space available basis.

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 must
attend Summer Study (usually held the last two weeks of July).

Signature_____________________________ Date ___________________________________

Respond to the items below on a separate piece of paper (or in audio or video format, if needed). You must respond to each question.

  1. Please comment on the interest the applicant has shown in attending a college after high school graduation.
  2. Describe the applicant's academic and/or career interests.
  3. Explain why you consider the applicant a good candidate for the DO-IT Scholars program.
  4. Provide additional information regarding the applicant that would be useful to the DO-IT selection board.
  5. Describe computers and/or assistive technology the applicant is using at home or school.

    Platform ________________ (e.g., Mac/PC)
    Model ________________ (Model name is written on the CPU box, e.g., Apple G2)
    CPU ________________ (e.g., Pentium, Power PC)

  6. DO-IT Scholars who do not have the necessary technology are loaned computer equipment while they participate in program activities. This may include computer, printer, software, adaptive technology, and Internet service. Please indicate the needed equipment:

    Computer ____________
    Printer ____________
    Software ____________
    Adaptive technology ____________
    Internet service ____________

About the DO-IT Scholars Program

The DO-IT Scholars multi-year program prepares young people with disabilities for college, careers, independent living, and leadership roles in society. It consists of three phases and after graduating from high school, the opportunity to be a DO-IT Ambassador. Key aspects of the DO-IT Scholars program include:

If you have questions about the Scholars program or this form, please contact DO-IT at:

888-972-DOIT (3648) (toll free voice/TTY)
doit@uw.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 reaffirms its policy of equal opportunity regardless of race, color, creed, religion, national origin, sex, sexual orientation, age, marital status, disability, or status as a disabled veteran or Vietnam era veteran in accordance with University policy and applicable federal and state statutes and regulations.

High School Teacher, Administrator, or Counselor Recommendation
DO-IT Scholars Program

Instructions: A teacher, counselor, or administrator must complete the form below and eight essay questions. Attach additional pages as needed to address the items below.

Return this form and attachments to the student applicant or to the DO-IT Center via

FAX: 206-221-4171
DO-IT Scholars Application, DO-IT Center, University of Washington, Box 354842, Seattle, Washington 98195-4842

Deadline: January 10th. For students to be considered in the selection process, application materials must be received by the DO-IT Center by January 10th. Applications received after January 10th will be reviewed on a space available basis.

Name of person recommending applicant (please print) __________________________

Position/Title ________________________________________________________________

Signature ________________________________________ Date	_______________________

Address _______________________________________________________________________

Telephone _______________________________________  Email ______________________

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 ______

Applicant's disability ________________________________________________________

Percentage of the applicant's time spent in Specially Designed Instruction (SDI)?
_________

Endorsement by School Principal (printed name and signature) 
_______________________________________________________________________________

Respond to items 1-8 on a separate piece of paper (or in audio or video format, if needed). You must respond to each question.

  1. What is the nature of the student's disability and how does it affect him/her academically?
  2. What types of accommodations and supports (including aides and attendants) does this student use at school presently?
  3. Please comment on this student's academic interests.
  4. Please comment on this student's potential to complete a college program.
  5. Please comment on how this student works in group learning environments.
  6. Please comment on this student's computer skills.
  7. Please comment on why you think this student is a good candidate for the DO-IT Scholars program. How would they benefit from this program as described in the DO-IT Scholar brochure.
  8. Additional comments (optional).

About the DO-IT Scholars Program

The DO-IT Scholars multi-year program prepares young people with disabilities for college, careers, independent living, and leadership roles in society. It consists of three phases and after graduating from high school, the opportunity to be a DO-IT Ambassador. Key aspects of the DO-IT Scholars program include:

If you have questions about the Scholars program or this form, please contact DO-IT at:

888-972-DOIT (3648) (toll free voice/TTY)
doit@uw.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 reaffirms its policy of equal opportunity regardless of race, color, creed, religion, national origin, sex, sexual orientation, age, marital status, disability, or status as a disabled veteran or Vietnam era veteran in accordance with University policy and applicable federal and state statutes and regulations.

Grade Report/Transcript for DO-IT Scholar Applicant

___ Please submit your current high school grade report or transcript with your application to

FAX: 206-221-4171
Mail: DO-IT Scholars Application, DO-IT Center, University of Washington, Box 354842, Seattle, Washington 98195-4842

and

___ Please also complete and submit the form below with your application to the DO-IT Center. This form is a tool for DO-IT to request grade reports directly from your school that may be issued after the application is submitted.

Student's name  _______________________________________________________________

Home address  _________________________________________________________________

Phone  ________________________________________________________________________

Birth date ____________________________________________________________________

Name of school ________________________________________________________________

Grade level in school _________________________________________________________

I request and give permission for high school grade reports/transcripts for the past 
two
years be sent to DO-IT (Disabilities, Opportunities, Internetworking,
and Technology) 206-221-4171 (FAX). 

Student signature _____________________________________________ Date __________

Parent/guardian signature _____________________________________ Date __________

Parent/guardian name (print) __________________________________________________

Please fax grade reports/transcripts to 206-221-4171 (FAX)

For information, call 206-685-DOIT (3648) (voice/TTY) or email doit@uw.edu

About DO-IT

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. DO-IT is a collaboration of UW Information Technology and the Colleges of Engineering and Education at the University of Washington.

Grants and gifts fund DO-IT publications, videos, and programs to support the academic and career success of people with disabilities. Contribute today by sending a check to DO-IT, Box 354842, University of Washington, Seattle, WA 98195-4842.

Your gift is tax deductible as specified in IRS regulations. Pursuant to RCW 19.09, the University of Washington is registered as a charitable organization with the Secretary of State, state of Washington. For more information call the Office of the Secretary of State, 1-800-322-4483.

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, request materials in an alternate format, or to make comments or suggestions about DO-IT publications or web pages contact:

DO-IT
University of Washington
Box 354842
Seattle, WA 98195-4842
doit@uw.edu
www.uw.edu/doit/
206-685-DOIT (3648) (voice/TTY)
888-972-DOIT (3648) (voice/TTY)
206-221-4171 (fax)
509-328-9331 (voice/TTY) Spokane

Founder and Director: Sheryl Burgstahler, Ph.D.

DO-IT Funding and Partners