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DO-IT Scholars Program Application

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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)

Student Application
DO-IT Scholars Program

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 355670
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 (__________)_____________________

Date of Birth_______________  Sex__________  Ethnicity_________________________

High School Name___________________________  Grade Level_______________________

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 or video tape, if your disability affects your writing). You must respond to each question.

  1. Please describe your interest in your two favorite academic courses (e.g., science, math, etc.) and explain why.
  2. Describe your educational 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 pursuing higher education.
  4. What is the nature of your disability and how does it affect your learning?
  5. What types of accommodations and/or support persons (including attendant) do you use at school presently?
  6. Describe your computer and internet experience (if any).
  7. If you have experience using computers, does your disability require that you use special software or hardware in order for you to use a computer and, if so, what adaptive computer hardware and/or software do you find most useful?
  8. Please 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).
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.

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

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 355670
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.washington.edu 

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 ____________________

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 him/her academically?

What percentage of the student's time is spent in Specially Designed Instruction (SDI)? ______________

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.

Parent/Guardian Recommendation and Consent DO-IT Scholars Program

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 355670
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 (please print)___________________________________

  1. Please comment on the interest that the applicant has shown in attending a college or university after high school graduation.
  2. In what areas has the applicant shown academic or career interests?
  3. Why is the applicant a good candidate for this program?
  4. Provide additional comments or information regarding the applicant that would be useful to DO-IT program staff.
  5. Please describe any adaptive 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, etc.)

  6. 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 ____________

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 last two weeks of July). 

Signature__________________________________________________ Date______________________

Name of parent/legal guardian (please print)  ________________________________________

Address_______________________________________________________________________________

Telephone (_______)____________________ Email_________________________________________

Name of additional parent/legal guardian(s) (please print)  __________________________

Address_______________________________________________________________________________

Telephone (_______)____________________ Email_________________________________________

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.

Official Grade Report/Transcript Request Form for DO-IT Scholars Applicant

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 355670
Seattle, Washington 98195-5670

FAX 206-221-4171
For information about DO-IT, call 206-685-DOIT (3648) (voice/TTY).

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