PSapplication Home > Misc Landing Pages > PSapplication A A A Project SEARCH® Application 2020-2021 Application Purpose and Guidelines The purpose of this application is to outline the skill set of the Project SEARCH® candidate. This application then allows the Selection Committee to properly assess each candidate’s skills, abilities and background. The individual, a parent, other support staff, or employer may be contacted by the Selection Committee to gather additional information. Our final goal is to select students who will be successful in a Project SEARCH® program and reach the outcome of competitive employment. The selection process includes the following guidelines: 1. Recruitment is typically held in the Spring of each year. However, there may be exceptions for entrance throughout the year. To ensure proper assessment, all candidates must complete this packet to be considered for participation in the Project SEARCH® Program. 2. All candidates are encouraged to attend an informational meeting to learn about possible rotations and meet the instructor prior to being selected to participate in Project SEARCH®. 3. The Selection Committee will match each candidate’s skill sets and interests with the work experience which will maximize job skill building and the opportunity for career exploration. The Project SEARCH® at Jewish Senior Life Selection Committee consists of representatives from the following organizations and agencies: Jewish Senior Life Heritage Christian Services ACCES-VR OPWDD By completing and signing this application, the applicant and family hereby provide consent for these agencies to share information, via email, phone, written, or in person, which may including status of eligibility with ACCES-VR and OPWDD during the application process. If accepted into project SEARCH®, these partners are hereby given consent to continue to share information regarding progress through out participation in Project SEARCH® and beyond into competitive and/or supported employment. Project SEARCH® Application The following is to be completed by the individual, parent/guardian, or support staff.Candidate Name* First Last Candidate Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Date of birth*Candidate Email* Candidate PhoneWhat month and year do you hope to start attending Project SEARCH at Jewish Senior Life?The program year generally runs from September to June but there may be some flexibility with when you begin.Parent/Guardian information:Parent/Guardian Name First Last Parent/Guardian Cell PhoneParent/Guardian Email Parent/Guardian Work PhoneCare Coordinator Information:Care Coordinator Name* First Last Care Coordination Agency*Care Coordinator Email* Care Coordinator Cell PhoneCare Coordinator Work PhoneCandidate ACCES-VR Status:Do you work with or have you ever worked with ACCES-VR? Yes No ACCES-VR Counselor Name* First Last ACCES-VR Counselor Email* ACCES-VR Counselor PhoneCandidate OPWDD Status:Have you applied for OPWDD Services? Yes No Have you been approved for OPWDD services? Yes No Do you have a self-directed plan? Yes No Fiscal Intermediary/Broker Name* First Last Fiscal Intermediary/Broker Email* Fiscal Intermediary/Broker PhoneCandidate Medicaid Status:Do you receive Medicaid? Yes No Candidate SSI/SSDI Status:Are you receiving SSI and/or SSDI benefits? Yes No Candidate Guardianship Status:Are you your own legal guardian? Yes No If no, who is your legal guardian?*Vocational Training/Post-Secondary EducationHighest Level of Education*CollegeSome collegeHigh School diplomaOther High SchoolSchool(s) AttendedCredentials CDOS IEP (before 2014) Local Diploma Regents Diploma GED/TASC (High school equivalency) Other If you marked 'other' above, please explain:*Have you taken any career/technical education courses? Yes No If yes, which course was taken, and did you complete the course?*Employment Background:List current or previous jobs both paid and volunteer. Include employer, job title, supervisor's name, contact number and if the position was paid or unpaid.Please describe your job duties and any notable achievements.Were you ever asked to leave a job?* Yes No If yes, please explain.*Transportation:If accepted, how do you plan to get to Project SEARCH®?Do you currently drive? Yes No Do you plan to get your license within the next year? Yes No Do you have experience riding public transportation? Yes No Are you willing to complete Travel Training? Yes No Do you live on or near a public bus route? Yes No Unknown Will you need assistance to plan your transportation to and from Project SEARCH®? Yes No Services Agencies:What community agency services have you utilized in the past (other than ACCES-VR and OPWDD)? Include agency name and purpose of service.Independent Living:Do you currently have an Individual Plan of Protection / Safeguards?* Yes No Level of independence in the community (please select one):* I can go places by myself I need some help making plans Someone is with me all the time when I go out Other If you selected 'other' above, please explain:*Please explain what support you need. Include how much time alone you have.List any current medications.Do you self-administer your medications? Yes No Please list any mental health, medical concerns or limitations that may impact employment.Do you get up in the morning on your own? Yes No Do you need any reasonable accomodations other than coaching support for an interview or during an internship? Yes No If yes, please explain:*Is there anything else you need assistance with that may come up at program (ex: health needs, mental health needs, or physical needs)? Yes No If yes, please explain:*Goals:What is your employment goal?What is your independent living goal?What is holding you back from employment now?What is holding you back from independent living now?References:Please list up to three references (not a family member) who would be able to provide helpful background knowledge about your skills and abilities to the Project SEARCH® Selection Committee. Please notify references that you are listing them, as they will be contacted. (Examples may include a teacher, counselor, care coordinator, work study/job supervisor).Reference #1 Name* First Last Reference #1 Relationship*Reference #1 Phone*Reference #2 Name* First Last Reference #2 Relationship*Reference #2 Phone*Reference #3 Name* First Last Reference #3 Relationship*Reference #3 Phone*Candidate Response Questions:Please respond with at least 4-5 sentences in answering these questions.What do you know about Project SEARCH®?*Why do you think Project SEARCH® would be beneficial to you? What do you hope to gain?*This application has been completed by:*If support was provided to complete the application, list name and relationship to candidate:What month and year do you hope to start attending Project SEARCH at Jewish Senior Life?Project SEARCH® Information Release FormI hereby authorize Project SEARCH® and the following organizations as marked to release information to and receive information from, possibly via email:* Select All OPWDD (Office of People with Developmental Disabilities) Heritage Christian Services Strong Center for Developmental Disabilities ACCES-VR (Adult Career and Continuing Education Services – Vocational Rehabilitation) School District (specify below) Care Coordination Agency (specify below) Broker (if indepenent) Other (specify below) Specify name(s) of school district, care coordination agency, broker or other:*The following information will be exchanged, possibly via email, to help the candidate in his/her/they pre vocational program and employment supports (select all that apply):* Select All Psychiatric / Psychological reports Vocational skills assessment Teacher observations / School records Social history / Family information Progress reports Attendance data Medical reports Report cards Neurological reports Admission / discharge reports IQ test scores, aptitude and achievement tests Behavior reports ISP / Life Plan, including attachments Other If you selected 'other' above, please list:This release is valid for 12 months from the date of signature and may be revoked by notifying Heritage Christian Services Project SEARCH® Supervisor in writing or witnessed verbally. I have read this form carefully and understand what it means. Candidate AgreementI understand that by checking the agreement below that I am indicating my interest in being considered for acceptance into the Project SEARCH® program. If I am selected, I agree to abide by the following terms and conditions: • I will complete up to three unpaid, time limited, work experiences within the host business. • I agree that the purpose of the unpaid work experiences are for my vocational exploration, skills assessment, and training. • I will attend the program every day, Monday-Friday, during regular program hours and maintain a minimum of 95% attendance to maintain my spot in Project SEARCH®. • I will dress appropriately and wear required attire. • I will call my instructor and departmental supervisors when I am absent or tardy. • I will make up and instructional work missed due to absences as appropriate. • I understand that I am responsible for transportation to the host site. • I will participate in a travel training, and will learn to use public transportation if necessary. • I will follow all rules established by the program and host businesses. • I will take direction from the Project SEARCH® instructors and coaches, as well as supervisors and coworkers on internship sites, and be willing to accept feedback and develop appropriate workplace behaviors. • I will attend scheduled meeting with my support team and business staff. • I will strive to meet expectations as communicated by the departments that oversee my internships. • I will be an active participant and communicate any issues to my support team. • I will work towards independence in the community. • I will actively pursue employment upon completion of Project SEARCH®. • I will follow the Jewish Senior Life code of conduct. • I allow the partners of Project SEARCH® at Jewish Senior Life to share information regarding my progress in the program. • I understand that by participating in Project SEARCH® Jewish Senior Life, I am not entitled to a paid position upon completion of the program. I have read the above terms and conditions and agree to abide by them if I am selected to participate in the Project SEARCH® program. I understand that I may be asked to leave Project SEARCH if I fail to follow these terms and conditions. Consent I have read the above terms and conditions and agree to abide by them if I am selected to participate in the Project SEARCH® program. I understand that I may be asked to leave Project SEARCH if I fail to follow these terms and conditions.Additional Requirements:Please upload: Copy of current ISP/Life Plan, safeguards, psychological evaluation, and behavioral support plan (both current and past, if applicable), copy of IEP, employability profile, if within one year of leaving high school, resume, copy of all community-based work assessments and letters of recommendation: File Drop files here or Select files Accepted file types: pdf, doc, docx, Max. file size: 300 MB. reCAPTCHA*