ACES Pre-Application Interest Form: Tell us about you...

First Name

Last Name

Middle Name or Initial

Email Address

Confirm Email Address

Birth Date

Enter your birthdate in a mm/dd/yyyy format.

Gender

Citizenship Status

Preferred Phone

Mobile Phone

Please enter in a ###-###-#### format.

Home Phone

Please enter in a ###-###-#### format.

May we text you about ULM's ACES program?

Check if your address is outside the U.S. or CanadaYesNo

Street Address or PO Box (include Apt/Suite/Lot # as applicable)

City or Town

State or Province

ZIP or Postal Code

Country

Parent/Guardian Info

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email Address

Parent/Guardian Mobile Phone

Parent/Guardian Home Phone

Ethnic/Race Information

Ethnicity

Providing information in this section is optional.

Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member:

American Indian or Alaska NativeYesNo

AsianYesNo

Black or African AmericanYesNo

Native Hawaiian or Other Pacific IslanderYesNo

White/CaucasianYesNo

Your Current Education Information

Current or Last High School attended

Are you currently enrolled in High School?

Did you have an IEP, 504 Plan, or IFSP in High School?

Your ULM Academic Plans

Please select "Undeclared/Not Sure"

Please select the upcoming Fall Term

Exceptionality or Disability (select all that apply)

Autism/Autism Spectrum Disability (ASD)

Intellectual & Developmental Disability (IDD)

Other Disability (please specify)

How will you get to ULM? (select all that apply)

Parent/Guardian

Car

City Bus

Other (please specify)

Additional Information

Do you have a Driver's License?

Do you have a Paid or Volunteer Job?

List any Assistive Technology you have used

Tell us why you want to participate in the ACES Program

ACES Eligibility and Program Agreements

To be eligible to join an ACES cohort, the applicant:
1. must have a documented Intellectual Disability, either primary or secondary.
2. must be between the ages of 18 and 23.
3. should be able to sit through 90-minute courses.
4. should be comfortable around large groups of people.
5. must have a history of good behavior in school.
6. must be independent in handling medication and dietary needs.
7. must be self-motivated and adhere to all ULM policies.
8. have access to technology.
9. must have transportation to and from the ULM campus.
10. must participate in an interview with the program coordinator and have potential for achieving student centered goals based upon interview and review of records. The ACES committee will review applications and the final admission decision will be made by the program coordinator.

Do you meet these ACES requirements?

I Agree

If accepted, I agree to follow the rules established by ACES and the parent or guardian listed above can be contacted regarding my ACES Program submission.

YesNo

I Agree

I acknowledge that funding to cover expenses must be paid prior to my first day of class.

YesNo

I Agree

In signing this pre-application, I acknowledge my answers are true to the best of my knowledge. I also agree to waive my right to confidentiality and authorize communication between the LEA (Local Education Authority), in support of my application to and enrollment in this program. I also agree to submit needed documentation such as current IEPs, transition plans, IFSPs, and evaluation documentation. I also agree to attend one interview and participate in job/career assessments as needed to provide information to the ACES committee.

YesNo

Signature and Submission

Type your full legal name in the "Electronic Signature" box to confirm that this qualification you have filled out is your own work and the information is factually true. Once you type in your full legal name, this will count as your electronic signature.

Electronic Signature