Parent/Guardian Recommendation and Consent Neurodiverse Learners (NNL) Program

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 page.

You can also access the full application in Spanish, Russian, or Vietnamese.

Instructions: A parent or guardian must complete the form below and the short essay questions.

All NNL program offerings are contingent upon receipt of continued funding. All participants are required to be citizens or permanent residents of the United States or its possessions. 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.

View UW and DO-IT’s Privacy Practices for Youth Programs here: English | Spanish | Amharic | Arabic | Chinese | Somali | Vietnamese


Primary Parent/Guardian Contact Information
Please use the format XXX-XXX-XXXX