JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
ONAbility Program Enrollment
Please complete this form completely.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Personal Information
Student Full Name
*
Your answer
Student Preferred Name
*
Your answer
School District of Student
*
Your answer
Student Address
*
Your answer
Student date of birth
*
MM
/
DD
/
YYYY
Student phone number
*
Your answer
Student email
*
Your answer
Student sex at birth
*
Male
Female
Student gender identification
*
Male
Female
Non-binary
Guardian/Parent Contact Information
Guardian/Parent Name(s)
*
Your answer
Guardian/Parent address
*
Your answer
Guardian/Parent phone numbers
*
Your answer
Guardian/Parent emails
*
Your answer
Do you have guardianship of the student?
*
yes
no
Parent/Guardian Question
What are your goals for your child for ONAbility? What would you like to see them achieve from this program? Please be specific and list 3-4 tasks that you feel would benefit your student in living as independently as possible after high school.
*
Your answer
Student Questions
At the end of this school year, will you have met graduation requirements?
*
Yes
No
What are your plans after high school?
*
Your answer
How can ONAbility support you in obtaining these goals? Choose all that apply.
*
To increase my literacy and/or math skills so that I can live independently
To learn independent living skills (cooking, transportation,cleaning, shopping, meal prep, ect)
To learn the skills I need to get and keep a job
To decide on the job/career that I want
To learn how to ride the MTU bis and Shared Ride to access the community
To improve my interpersonal communication skills
Other
Required
If listed other above, please explain.
Your answer
How do you plan to get to ONAbility?
*
Self
Family
School
Public
Other
Required
Work Experiences- Choose all that apply
*
Work in my school
Volunteer work supported by my school
Volunteer work independently
Job shadow
Internship
Paid word
I have a paying job now
Unsure
Required
Please list any work experice that you may have checked above. For example: Goodwill School-to Work program, volunteer at church, Work at Culvers.
*
Your answer
List any health or medical issues that may impact the ability for you to participate in transitional activities or concerns that we should be aware of.
*
Your answer
Please explain any accommodations that you may need on a job.
*
Your answer
Please explain any assistive technology that you are currently using.
*
Your answer
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of School District of Onalaska.
Report Abuse
Forms
