NNL Recommendation from a Teacher, Counselor, Administrator, or Coach

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This form is part of the application packet for the Neuroscience for Neurodiverse Learners (NNL) Program. To learn about the other components of the program, visit the Summer Program and Year-Round Activities pages.

Instructions: A teacher, counselor, administrator, or coach must complete the form below and the short essay questions. If you prefer, you can print this form and submit it to DO-IT by postal mail, fax, or email.

About You

First Name *

Last Name *

Position/Title

Phone *

Email *

Student applicant's First Name *

Student applicant's Last Name *

High School Name *

School Address1 *

School Address2

School City *

School State *

School Zipcode *

About Applicant

Grade level, current academic year *

How much time do you spend with the student per week? *

Applicant’s disability *

Percentage of the applicant’s time spent in Specially Designed Instruction (SDI)? *

Indicate academic area of SDI *

Respond to each of the questions below. You may enter text in the field provided or upload a single alternative file, if needed. Your honest and thorough assessment of this applicant is helpful.

1. What is the nature of the student’s disability and how does it affect them academically? *

2. What types of accommodations and supports does this student use at school presently? *

3. What academic and social support are they receiving to promote their success as they transition toward college? *

4. Please comment on why you think this student is a good candidate for a STEM program. *

5. Additional comments (optional).

File Upload (alternative format for Questions 1-5)

10 MB size limit
Files must be less than 10 MB.
Allowed file types: txt rtf html pdf doc docx ppt pptx xls xlsx xml avi mov mp3 ogg wav.

Leave this field blank