Download and complete the following forms. Be sure to upload the completed forms in your application. Student Services Plan Request – Form DR 203 Consent to Release and Obtain Information – Form DR 260 Please be advised: Parental or Guardian signatures is mandatory on all forms for youth ages 16 and 17 Please upload below any supporting documents for proof of eligibility like IEP or 504 "*" indicates required fields Application InformationName First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Primary PhoneSecondary PhonePrimary Phone Number Type Cell Phone Relatives Work Home Other Not Identified Email Address (Required). Please DO NOT note a School Affiliated Email Address* If a Teacher or a Parent/Guardian is Helping you Complete this Application, Please Write their Email Address. Date of BirthMonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age at ApplicationPlease enter a number from 16 to 21.Gender—FemaleMaleDecline to StateRace/Ethnicity Asian American Indian or Alaska Native Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White Decline to State Mixed race SchoolCurrent High School or College you are attending*Current Grade Level—FreshmanSophomoreJuniorSeniorWhat is your Expected Graduation Date?*If you are in an Adult Transition Program, please write the name of your ATP Teacher below. If you are not in ATP, leave the field blank.Do you have an IEP?* Yes No I do not know what an IEP is Do you have a 504 Plan?* Yes No I do not know what a 504 Plan is Support Services NeededThe STEPS training may be conducted through Zoom. Do you have technology to access the training such as a Smartphone, Computer, Tablet?* Yes No The STEPS program includes up to 170 hours of paid work experience. Do you have transportation to get to a worksite?* Yes No How will you get to your worksite?*—CarBusRideOtherPlease describe how you'll get to the worksite.The STEPS program includes interviewing with employers. Do you have interview clothing?* Yes No Click to UploadUpload Form DR 203*Accepted file types: jpg, gif, png, pdf, Max. file size: 29 MB.Upload Form DR 260*Accepted file types: jpg, gif, png, pdf, Max. file size: 29 MB.Upload IEP or Post Secondary Registration*Accepted file types: jpg, gif, png, pdf, Max. file size: 29 MB.Click to ConsentI hereby certify that all information and other statements made by me in this application and attached documents are true and correct.* I hereby certify that all information and other statements made by me in this application and attached documents are true and correct. CAPTCHANameThis field is for validation purposes and should be left unchanged.
