Student Application 2019-2020 - Washington State University
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2019-2020
Student Application
1Program Information
The WSU ROAR (Responsibility, Opportunity, Advocacy, and Respect) is a two--year
inclusive and residential post-secondary education program for students with
intellectual and developmental disabilities (IDD). The program will provide individualized
programs of study in academic skills, social skills, independent living skills, and
vocational training.
Participation in the WSU ROAR program will not only provide students to continue their
education and seek vocational skills beyond their high school career, but it also provides
them with a true college Cougar family experience
2WSU ROAR Student Eligibility Information
Is an individual between 18 and 29 years of age;
Has moderate limitations in adaptive behavior and intellectual
functioning as expressed in social, practical, and conceptual adaptive
skills according to the American Association of Intellectual and
Developmental Disabilities (AAIDD, 2011);
Is seeking greater independence through enhancing social,
communication, vocational and life skills in a post-secondary education
program;
Is willing and able to live communally and independently with other WSU
ROAR students in campus housing (apartments) during the duration of
the program;
Has participated in a functional-based curriculum (K-12), received
services through an Individualized Education Plan (IEP), or
completed an alternate assessment portfolio; Has completed high
school with or without a typical high school diploma;
Is not able to enroll in a "traditional" college or university program, even
with accommodations;
Exhibits responsible and socially adaptive behavior without supervision;
Has sufficient emotional and independent ability to participate in all aspects
of the WSU ROAR Program;
Demonstrates the ability to accept personal responsibility for actions and
maintains respect for self and others;
Has no history of disruptive or aggressive behavior. Note: ROAR does not
have the
personnel necessary to manage behavioral issues.
Has the ability to independently self-administer and manage medication,
specialized dietary
and/or medical needs. Note: WSU ROAR personnel are not
available to manage/administer medication and takes no
responsibility for specialized diets or medical needs.
3Demonstrates at least a 4th grade reading level or higher. Students with
lower reading levels may be considered for conditional admission;
Demonstrates basic mathematical understanding and the ability
to use a calculator; Is able to communicate with others (with or
without assistive technology)
Can function independently and participate in semester-long workshops
and seminars that last between 90 minutes and 2 hours;
Can handle and adapt to change; is not overly stressed when things
change; and Demonstrate the potential to successfully achieve
personal and program goals within the context of the WSU ROAR
Program’s context and setting.
Please Note: The WSU ROAR Program does not have the personnel to
supervise students with difficult and challenging behaviors or to dispense
medications. The WSU ROAR program provides access, equal opportunity
and reasonable accommodations in its services, programs, activities,
education, and employment for individuals with disabilities.
If you or your student meet the required criteria above, you/they are a great
candidate for the WSU ROAR program. Please click next to continue with the
application for admissions.
Note: The WSU ROAR Program is a certificate program (not an accredited
college degree program) and exiting students will receive a vocational
certification, NOT a degree from Washington State University.
Note 2: During the 2019-2020 academic year, only 6 students will be admitted to
the program. Starting the academic year 2020-2021, 10 students maximum per
cohort will be admitted to the program.
4WSU ROAR Application Checklist
___Student application packet (including skills inventory)
___$25.00 non-refundable application fee payable to Washington State University
___Parent/Guardian Information to be completed by parent/guardian
___Release/Exchange Information Form
___High School Transcript
___Copy of student's IEP
___Educational Evaluation (ideally conducted within the past three years) such as:
Woodcock Johnson III or Revised Test of Achievement Peabody Individual
Achievement Test (PIAT)
Kaufman Test of Educational Achievement (KTEA)
___Current Psychological/Behavioral Evaluation (past 3 years)
___2 Letters of Recommendation
___Once the application has been reviewed, a personal interview with the student and
parent, family, guardian, or support person will be scheduled as determined by the
Admissions Committee.
Please submit all application materials that could not be uploaded and application fee
via mail:
WSU ROAR
P.O. BOX 642114
PULLMAN, WA 99164-2114
5Statement of Accurate Information
I understand that withholding information requested in this application or giving false,
misleading, or incomplete information will make me ineligible for admission to, or continuation
in, Washington State University's ROAR program. I furthermore pledge to submit any future
changes, including those related to grades or discipline issues, to the WSU ROAR Program
office and understand that an offer of admission maybe rescinded based upon updated
information. I certify that the information given is correct and complete.
I have read, I understand, and I agree to the above statement.
Student Signature ________________________________________________
Date ___________________________________________________________
6Personal Information
First Name ____________________________________________________________
Middle Name ___________________________________________________________
Last Name ____________________________________________________________
Date of Birth ___________________________________________________________
Mailing Address ________________________________________________________
_____________________________________________________________________
Email ________________________________________________________________
Cell Phone ____________________________________________________________
Other Phone ___________________________________________________________
7Parent/Guardian Information
Parent/Guardian 1
Name ________________________________________________________________
Mailing Address ________________________________________________________
Cell Phone Number _____________________________________________________
Other Phone Number ____________________________________________________
Email _________________________________________________________________
Parent/Guardian 2
Name ________________________________________________________________
Mailing Address (if different from Parent 1) ___________________________________
_____________________________________________________________________
Cell Phone Number _____________________________________________________
Other Phone Number ____________________________________________________
Email _________________________________________________________________
8Educational Information
List all the schools that you have attended (starting from the most recent)
School 1 ____________________________________________________________
School 2 ____________________________________________________________
School 3 ____________________________________________________________
School 4 ____________________________________________________________
School 5 ____________________________________________________________
Which of the Following best describes the curriculum and educational setting you experienced
in high school? Check one.
o Fully included in general education curriculum in general education classes
o Partially included in general education curriculum with majority of classes in general
education
o Student spent half of their time in general education and half of their time in special
education
o Partially included in general education curriculum with the majority of classes in special
education
o Not included in general education curriculum or classes. Only in special education
classes (e.g., life skills).
o Other, specify: ____________________________________________________
9What, if any, type of statewide assessment did you take while in high school? Choose one.
o Regular with or without accommodations
o Alternate
o Waived
o None
o Other, Specify ____________________________________________________
________________________________________________________________
Did you receive a general education high school diploma?
o Yes
o No
o I received one but the requirements for graduation were based on my IEP
o Other ___________________________________________________________
________________________________________________________________
In a few words, please describe your academic strengths and weaknesses
10In a few words, how do you think you learn best (For example: small groups, extra time)
What courses did you enjoy the most?
What courses did you enjoy the least?
Where you part of any organizations or clubs at your school? If so, which ones?
11Employment & Volunteer History
*Note: prior work experience is not a requirement for admission into the
WSU ROAR program
Employment or Volunteer Work 1
Name of the Company/Employer ___________________________________________
Job Title ______________________________________________________________
Dates of Employment (Start-End) ___________________________________________
Hours per Week ________________________________________________________
Job duties _____________________________________________________________
Pay __________________________________________________________________
Employment or Volunteer Work 2
Name of the Company/Employer ___________________________________________
Job Title ______________________________________________________________
Dates of Employment (Start-End) ___________________________________________
Hours per Week ________________________________________________________
Job duties _____________________________________________________________
Pay __________________________________________________________________
12Personal Support Inventory
Instructions: To be filled out by Parent/Family/Guardian/Support person. Please rate the
levels thoughtfully and honestly so that we can determine the best placement and level
of support for your student.
Please use the following scale to represent the level of functioning in each section:
o (3) Student is independent
o (2) Student requires some/moderate support
o (1) Student requires complete support
o N/A
13Eating and Food Preparation
14(1) Student (2) Student
Requires Requires (3) Student is Not Applicable
Complete Some/Moderate Independent (3) (N/A) (4)
Support (1) Support (2)
Gather
ingredients and
equipment (1) o o o o
Opens
containers (2) o o o o
Follows recipe
(3) o o o o
Uses microwave
(4) o o o o
Uses stovetop
(5) o o o o
Uses oven (6)
o o o o
Uses other
appliances (7) o o o o
Oral motor skill
(i.e., chewing)
(8) o o o o
Uses utensils (9)
o o o o
Uses manners
(10) o o o o
Sets table (11)
o o o o
Puts away
leftovers (12) o o o o
Wipes off work
surface (13) o o o o
Washes dishes
(by hand) (14) o o o o
15Washes dishes
(using
dishwasher) (15) o o o o
Uses adaptive
equipment (16) o o o o
(Required) Comments on any of these tasks and levels of functioning.
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
16Grooming and Dressing
(1) Student (2) Student
Requires Requires (3) Student is Not Applicable
Complete Some/Moderate Independent (3) (N/A) (4)
Support (1) Support (2)
Brushes teeth
(1) o o o o
Uses
mouthwash (2) o o o o
Brushes/combs
hair (3) o o o o
Skin care (4)
o o o o
Cleans
eyeglasses (5) o o o o
Cleans hearing
aides ear molds
(6) o o o o
Maintains
appearance
clean (7) o o o o
Dresses and
undresses self
(8) o o o o
Chooses
appropriate
clothing for
season/weather o o o o
condition (9)
(Required) Comments on any of these tasks and levels of functioning.
________________________________________________________________
________________________________________________________________
________________________________________________________________
17Hygiene and Toileting
(1) Student (2) Student
Requires Requires (3) Student is Not Applicable
Complete Some/Moderate Independent (3) (N/A) (4)
Support (1) Support (2)
Toileting needs (1)
o o o o
Washes hands (2)
o o o o
Bath/Showering (3)
o o o o
Shampooing/ringing
hair (4) o o o o
Managing
menstrual care (5) o o o o
Shaving (6)
o o o o
Uses deodorant (7)
o o o o
(Required) Comments on any of these tasks and levels of functioning.
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
18Sexuality, Health, Safety
19(1) Student (2) Student
Requires Requires (3) Student is Not Applicable
Complete Some/Moderate Independent (3) (N/A) (4)
Support (1) Support (2)
Awareness of
public and private
activities (1) o o o o
Closes door for
bathing, toileting,
dressing, etc. (2) o o o o
Appropriate show
of affection (3) o o o o
Knowledge of
Consent (self and
other people) (4) o o o o
Appropriate control
of sexual needs (5) o o o o
Awareness of
bodily and sexual
functions (6) o o o o
Knowledge and
use of birth control
methods (7) o o o o
Knowledge of
sexually
transmitted
diseases (8)
o o o o
Disease
transmission (i.e.,
covers mouth
when
sneezing/coughing,
controls drooling,
o o o o
blows nose, etc.)
(9)
Health concerns
specific to disability
(i.e., skin care,
range of motion,
position of weight)
o o o o
(10)
20Manages
medication (i.e.,
knows medication
schedule, ability to
swallow, related o o o o
behavioral
concerns) (11)
Cares for minor
injury and/or illness
(12) o o o o
Awareness of
Hazards and
Emergency
Procedures: o o o o
Poisons (13)
Awareness of
Hazards and
Emergency
Procedures: Fire o o o o
(14)
Awareness of
Hazards and
Emergency
Procedures: o o o o
Accidents (15)
(Required) Comments on any of these tasks and levels of functioning.
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
21Household Maintenance
(1) Student (2) Student
Requires Requires (3) Student is Not Applicable
Complete Some/Moderate Independent (3) (N/A) (4)
Support (1) Support (2)
Makes bed (1)
o o o o
Changes bed
linens (2) o o o o
Straightens
room (3) o o o o
Does laundry (4)
o o o o
Vacuums/dusts
(5) o o o o
Cleans
bathroom (6) o o o o
Sweeps (7)
o o o o
Cleans other
parts of the
house (8) o o o o
Cleans
appliances (9) o o o o
(Required) Comments on any of these tasks and levels of functioning.
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
22Travel
23(1) Student (2) Student
Requires Requires (3) Student is Not Applicable
Complete Some/Moderate Independent (3) (N/A) (4)
Support (1) Support (2)
Safely crossing
streets (1) o o o o
Identifies signs
(2) o o o o
Arrives at
destination (3) o o o o
Carries
identification (4) o o o o
Asks for help (5)
o o o o
Responsible for
possessions (6) o o o o
Uses caution
with strangers
(7) o o o o
Reads maps (8)
o o o o
When riding a
bicycle: knows
safety rules (9) o o o o
When riding a
bicycle: able to
find way (10) o o o o
When riding a
bicycle: locks
bicycle (11) o o o o
When riding a
school or city
bus:
demonstrates
appropriate o o o o
behavior when
on bus (12)
24When riding a
school or city
bus:
communicates
with the bus
o o o o
driver (13)
When riding a
school or city
bus: can find
appropriate bus o o o o
(14)
When riding a
school or city
bus: can read
bus map (15)
o o o o
When riding a
school or city
bus: can make a
transfer (16)
o o o o
When riding a
school or city
bus: knows how
to pay (17)
o o o o
When riding a
school or city
bus: show bus
pass (18)
o o o o
When driving
own vehicle:
knows laws (19) o o o o
When driving
own vehicle:
uses seat belt
(20)
o o o o
When driving
own vehicle:
knows what to
do in emergency o o o o
(21)
When driving
own vehicle:
uses appropriate
adaptive o o o o
equipment (22)
25When driving
own vehicle:
demonstrates
safe and
defensive
o o o o
techniques (23)
(Required) Comments on any of these tasks and levels of functioning.
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
26Using Services and General Shopping
27(1) Student (2) Student
Requires Requires (3) Student is Not Applicable
Complete Some/Moderate Independent (3) (N/A) (4)
Support (1) Support (2)
Makes
appointments (1) o o o o
Uses banking
services (2) o o o o
Uses/communicates
with doctor, dentist,
etc. (3) o o o o
Uses laundry/dry
cleaner (4) o o o o
Makes shopping list
(5) o o o o
Knows budget
constraints (6) o o o o
Handles money
exchanges (7) o o o o
Pushes cart at store
(8) o o o o
Uses store directory
(9) o o o o
Asks for help (10)
o o o o
Follows list (11)
o o o o
Makes appropriate
choices (12) o o o o
Does cost
comparison (13) o o o o
Select appropriate
store (e.g., grocery
store, clothing store,
pharmacy, etc.) (14)
o o o o
28Selects items within
budget (15) o o o o
Makes wise choices
(16) o o o o
At a restaurant:
"Reads" menu (or
alternative) (17) o o o o
At a restaurant:
Communicates with
waitperson (18) o o o o
At a restaurant:
Uses manners (19) o o o o
At a restaurant:
Locates restrooms
(20) o o o o
At a restaurant:
Tallies bill (including
tip) (21) o o o o
At a restaurant:
Handles money
exchange (22) o o o o
(Required) Comments on any of these tasks and levels of functioning.
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
29Planning/Scheduling
(1) Student (2) Student
Requires Requires (3) Student is Not Applicable
Complete Some/Moderate Independent (3) (N/A) (4)
Support (1) Support (2)
Shows up on time
(1) o o o o
Gets to where
they are supposed
to be (2) o o o o
Adapts to
changes in routine
(3) o o o o
Able to tell time
(4) o o o o
Uses a time
management
system (i.e.
calendar/daytimer) o o o o
(5)
Maps out plans
(i.e., organizes
time) (6) o o o o
Plans homework
time (7) o o o o
Arranges study
area (8) o o o o
Attends to
homework (9) o o o o
Plans time for
chores, meeting,
leisure time (10) o o o o
Arranges
transportation (11) o o o o
30Social Skills
31(1) Student (2) Student
Requires Requires (3) Student is Not Applicable
Complete Some/Moderate Independent (3) (N/A) (4)
Support (1) Support (2)
Phone etiquette
(1) o o o o
Takes message
(2) o o o o
Dials phone (3)
o o o o
Can use phone
in emergency (4) o o o o
Can use
assistive devices
if necessary (5) o o o o
Can text
message (6) o o o o
Can use the
internet or apps
on a smart
phone (7)
o o o o
Introduces self
(8) o o o o
Follows
instructions (9) o o o o
Accepts criticism
or
consequences
(10)
o o o o
Accepts no for
answer (11) o o o o
Greets people
(12) o o o o
Gets people
attention
appropriately
(13)
o o o o
32Makes requests
appropriately
(14) o o o o
Disagrees
appropriately
(15) o o o o
Gives negative
feedback
appropriately
(16)
o o o o
Apologizes (17)
o o o o
Engages in
conversation
(18) o o o o
Gives
compliments
(19) o o o o
Volunteers (20)
o o o o
Reports peer
behavior
appropriately
(21)
o o o o
(Required) Comments on any of these tasks and levels of functioning.
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
33Personal Essay
This section is to be filled out by the student applicant. This is an opportunity to
demonstrate writing skills. Please write answers to each question in a Word file
and attach it to the application.
Questions:
1. What are your strengths?
2. What are some of your favorite things to do in your free time (e.g., hobbies,
volunteer, etc.)? Why do you want to attend WSU?
3. Since part of the WSU ROAR program is to live on campus at apartments with
other WSU ROAR students as roommates, what will be some thing you would tell
them about yourself? Think about likes and dislikes and how you handle difficult
or stressful situations, when living with others (e.g., siblings, family, guardians,
roommates).
4. What would you like to study or pursue as a career?
5. Do you want to get a job after college? If so, what is your dream job?
6. After college, where would you like to live? (with family, your own apartment, with
roommates, group home, etc.)
34Letters of Recommendation
Two letters of recommendation are required:
- Two (2) Professional letter (non-relative that knows the student professionally -
e.g., teacher, employer, etc.)
- Please submit directly to coe.roar@wsu.edu or mail it to our address:
WSU ROAR
P.O. BOX 642114
PULLMAN, WA 99164-2114
Letters of recommendation must include:
o Name of the applicant (student)
o Relationship to applicant
o Length of Relationship (Years/Months)
o Description of relationship with applicant
o Description of why you feel the applicant will benefit from attending the WSU
ROAR program at Washington State University
o Using examples from your relationship with the applicant, describe their desire to
learn.
o What do you think the applicant would like to study or pursue as a career? Why?
o Since a large part of the WSU ROAR program is to live on campus at apartments
with other WSU ROAR students as roommates, what will be something you could
tell us about the applicant in relation to living with others? For example, likes and
dislikes, or how the applicant handles difficult/stressful situations when living with
others (e.g., siblings, family, guardians, roommates). Describe
parent/family/guardian support of the student
35Academic Transcript
Please attach the latest and official academic transcript to this application.
36Academic Honesty Statement
An essential policy of Washington State University is a commitment to maintaining an
atmosphere of intellectual integrity and academic honesty. As a student of the university, I
pledge that I will not knowingly give or receive any inappropriate assistance in academic
work, thus affirming my own personal commitment to honor and integrity. As an example,
parents or family members are not to complete student’s work.
By signing below, I agree and understand the Washington State University Academic Honesty
Statement
Student Signature ________________________________________________
Date ___________________________________________________________
37WSU ROAR Program Release and Exchange of Information Form
Washington State University treats and regards all written documentation obtained to verify a
disability and plan for appropriate services as well as all documented serves and contracts with
the WSU ROAR program as confidential. However, it may be necessary for our staff to
exchange some information about you (the student) with third parties in order to provide
educational opportunities and experiences on and off campus. This exchange will occur only
with your written permission, as given in this document below, and with the understanding that
only information necessary for the purposes of accommodation and academic progress will be
communicated.
▢ Name (1) ________________________________________________
▢ I give permission to exchange information about me with the offices/individuals
checked below: (2)
▢ School District(s) (3)
________________________________________________
▢ School Personnel (list schools) (4)
________________________________________________
▢ Division of Rehabilitation Services (5)
▢ Department of Intellectual and Developmental Disabilities (6)
▢ Parents/Guardians (10)
▢ Other, specify (13) ________________________________________________
I agree, as part of the application process, to waive my right to access the student
recommendation form. Additionally, I hereby give permission for the WSU ROAR Program at
Washington State University the right to use my photograph and/or quotes and videotapes of
me for public relations and/or training purposes. I am aware that I am participating in a pilot
38research program and that aggregate data (data about the entire group) from this program will
be collected and disseminated.
Student Signature ________________________________________________
Parent and/or Guardian Signature (if applicable) ________________________________
39Thank you!
Thank you for applying to the WSU ROAR program. The Admissions Committee will
review applications and select students for admission. Please do not call about the
status of your application, as we will not be able to provide this information over the
phone or electronically. Admissions decisions will be sent via email, phone call, or
standard mail. The Admissions Committee will decide to offer or deny admission to the
program based on its best judgment and the best interest of the applicant based on the
eligibility criteria. Partial applications will not be considered.
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