Short Course Application

SHORT COURSE PROGRAMS APPLICATION 2019-2020

Should you have any problems or questions regarding the completion of any part of this application, please contact Jeff Bowler at 360‐947‐3367 or e-mail: jeff.bowler@wssb.wa.gov

Eligibility: Washington State middle and high school students functioning at or near grade level. For technology sessions, students need the ability to touch-type. Please return this application by the registration deadlines posted below each course.

Application completed by: *

Student's Name *

Parent/Guardian Name *

Student Address *

Country

City

State

Zip code

Parent/Guardian Address (If different)

Country

City

State

Zip code

Student Date of Birth *

Age *

Gender

Student Cell Phone Number

Student Email

Parent/Guardian Phone Number (home) *

Parent/Guardian Phone Number (cell) *

Parent/Guardian Email *

Emergency Contact Name *

Emergency Contact Phone *

Grade Level Attending *

Name of School

Vision Teacher or Guidance Counselor Name

Vision Teacher Phone Number

Vision Teacher Email Address

Short Courses

Please indicate two specific courses you are applying for (two per school year):

Low Vision Access

September 16-20 (Apply by August 23rd)

Where assistive technology and compensatory access meet -providing modern tools, tips, and techniques toward increased access to the world of the low vision student.

Cane Camp

October 14-18 (Apply by September 20th)

Students learn a variety of different orientation and mobility skills in this week-long motivational course teaching the safe, efficient, and effective movement through various environments. Camping gear not required!

Cooking

November 4-8 (Apply by October 11th)

Learn about new strategies and tools for visually impaired cooks to create joy from the kitchen -just in time to help with holiday cooking.

Assistive Technology

December 9-13 (Apply by November 15th)

Whether working with Google or JAWS, we’ve got you covered with that extra boost you may need to make your technology start working for you.

Social Skills (Middle School)

January 13-17 (Apply by December 23rd)

One of our most popular classes, and a great class for middle school youth to learn how to act appropriately in different situations, make new friends, and use effective social communication skills.

Independent Living Skills

February 3-7 (Apply by January 13th)

A course that teaches you about independent living skills that are off the typical path of what you would typically learn about in an ILS class. We cover everything from locating and using a water shut-off valve to stop a flooding toilet -to steps you should take for protection in case of a home fire.

Career Education (High School)

March 9-13 (Apply by February 17th)

Literature states that career education should begin by at least 9th grade and starts with learning career awareness. Later, students move into career exploration, then preparation, and eventually -placement. Students will have the opportunity to participate in the annual NW Youth Career Expo in Portland, OR where they can learn about interviewing, resumes, soft skills, tricks to begin your career search, visit many booths of NW employers and colleges, etc. This week will be a whirlwind of information and activities for students to move closer toward what they may want to venture toward in life.

Middle School Transition (5th / 6th Grade)

April 6-10 (Apply by March 16th)

Transitioning from elementary to middle school can be a real challenge with different environments, schedule structures, and expectations. This course to include compensatory access, assistive technologies, orientation and mobility, self-determination, and other useful tips learned through shadowing WSSB middle school students, presentations, activities, and discussions.

Social Skills (High School)

May 11-15 (Apply by April 20th)

Learn about effective social communication, happiness and self-esteem, cooperative skills, dating etiquette, employment soft skills, and more tailored to high school youth. Held during the Lions Track Meet. *Registration beyond deadlines to be evaluated on a case-by-case basis

Medical/Special Needs Information

To ensure the safety and well-being of all students, please provide full disclosure to the following questions. Lack of disclosure or incomplete information regarding medical, behavioral or emotional issues that could potentially interfere with a student’s participation in program objectives, or that could affect the safety and well-being of short course participants and staff, will be grounds for termination from the program.

Please define student's visual impairment, diagnosis and acuity: *

Other Disabilities (if any):

Please describe any medical, emotional and/or psychological considerations, medications, or conditions (if any):

Please describe any special accommodations you might need in order to participate, if any (wheelchair accessibility, etc.):

Please describe any dietary restrictions you have (vegetarian, food allergies, etc.):

Orientation and Mobility

Has student had training from an O&M instructor?

Yes

Instructor's Name

Student’s mode of travel in familiar environments? Please mark all that apply:

Visual

Cane

Sighted Guide

Dog Guide

If you use a long white cane, describe your proficiency:

How independent of a traveler is the student? Please select one or more:

Residential only

Light business

Independent in unfamiliar areas

Use public transportation

Please bring your long white cane to short course with you.

Daily Living Skills

Has student ever stayed overnight away from home?

Yes

List which household responsibilities/chores student has?

Is the student Independent in dressing?

Yes

Is the student independent in personal hygiene?

Yes

Parents, please list any important information, concerns, or specific night or morning routines for students staying overnight in the cottages:

Independent living skills (briefly describe)

Prepare simple meals?

Yes, with assistance

Yes, without assistance

Wash & maintain clothing?

Yes, with assistance

Yes, without assistance

Shopping?

Yes, with assistance

Yes, without assistance

Manage own money?

Yes, with assistance

Yes, without assistance

Have a checking/saving account?

Yes

Keep schedule/make own appointments?

Yes, with assistance

Yes, without assistance

Current Tools & Techniques Used for School & Home

Other tools & techniques you currently use:

You will be contacted soon following review of your application. If approved, you will be receiving a Welcome Letter and necessary permission form packet to complete. Please note that the Medical Evaluation Form within this packet will require completion by a health care professional and can take time to get completed, thank you.

Washington State School for the Blind

Attn: Short Course Program
2214 E 13th Street Vancouver WA 98661
office@wssb.wa.gov
Voice: (360) 947-3309
Fax: (360) 737-2120