Project Pass application

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Complete this form to be eligible for our first year transition program.

Students seeking ONLY ACCOMMODATIONS do not complete this application.

Email *

Today's Date *

YYYY

First and Last Name

M Number

Did you receive accommodations in high school?

Yes

Clear selection

What type of accommodations did you use in high school?

High school GPA?

Will you transfer credit (AP, Dual, or College transfer)?

AP credit

Dual credit

College transfer credit

Clear selection

If you will have dual and transfer credit, what college did you attend and include dates of attendance?

FAMILY INFORMATION

Please provide contact information for your family

1st Parent's/Guardian's Name, phone number and email address:

2nd Parent's/Guardian's Name, phone number and email address:

If you do not live with both parents, who do you reside with?

STUDENT INFORMATION

Student should answer on their own

Class and Testing

I can do this on my own

I need support

I need a lot of support

I want support

Not applicable

I can take notes during an hour lecture

I can take exams in a room with 30-50 people

I can read 50-100 pages a week

I will ask questions if I do not understand

I understand my diagnosis and impact on my learning

Clear selection

Studying and Organization

I can do this on my own

I need support

I need a lot of support

I want support

Not applicable

I have a variety of good study skills

I use a planner or organizational system

I set reminders for work and appointments

I remember appointments

I do not procrastinate

Clear selection

Personal

I do this on my own

I am working on this

I struggle with this

Not applicable

I take my medicine without being reminded

I wake up by myself before 9 am

I have good communication skills

I take care of myself without reminders (hygiene, cleaning room, laundry)

I see a therapist or counselor

Clear selection

ESSAY

Student should answer on their own

Please describe yourself. Tell me about your interests, hobbies, clubs etc.

Please describe how your disability/disorder affects you as a student and/or in your daily life.

Why did you choose Murray State University?

Why do you want to attend college?

What types of classes do you like best and why?

What subjects do you struggle with?

Project Pass information and requirements

Project Pass is optional and students should use all components for at least the first semester

CTS 101 is a 3 hour course in the fall and CTS 102 is a 1 hour course in the spring.

I understand choosing this means:

I will take both classes;

I will be required to attend Smooth Move- early move in program;

I must use a mentor during my first semester;

I will use the office for accommodations for many of my classes.

Yes

I am interested in a different path

Clear selection

I am interested in SMOOTH MOVE which is our early move in program to help with learning about campus. I understand I must participate in all activities for all 2 days.

* This is required if taking CTS classes.

Yes, I am interested in moving in early.

No, I am not interested in moving in early. Please explain in other.

Other:

Clear selection

I am interested in using a Peer mentor and/or Academic tutor in my first semester.

*This is required if taking CTS classes.

*This is available without Project Pass participation.

Yes

Clear selection

Submit

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