How did you hear about the LifeWorks Bridge Academy? --None-- From another student, faculty, or college staff member College newsletters or blogs Internet search Social media College website or portal Campus event, fair, or information session Other Who is filling this application out? --None-- Myself (Applicant) Family Other Preferred Contact Method --None-- Phone Email Applicant First Name Applicant Last Name Applicant Date of Birth Applicant Email Applicant Phone Street City State/Province Zip Parent/Guardian Name Parent/Guardian Phone Number Parent/Guardian Email Address Which KCTCS college are you attending or planning to attend? --None-- Ashland Big Sandy Bluegrass Elizabethtown Gateway Hazard Henderson Hopkinsville Jefferson Madisonville Maysville Owensboro Somerset Southcentral Kentucky Southeast Kentucky West Kentucky What year student are you? --None-- Incoming Student 1st Year Student 2nd Year Student More than 2nd Year Student What is your student status? --None-- Part Time Student Full Time Student Have you ever received or do you currently receive OVR services? --None-- Yes No Unsure If yes, please list the name(s) of your OVR counselor. List any formal autism or other diagnoses you have. Which program outcomes are you most interested in growing in by being part of the LifeWorks Bridge Academy? Employability Housing & Transportation Health, Wellness, & Nutrition Life Skills Relationships Financial Management Adaptability Personal Safety Social & Leisure Why do you want to participate in the LifeWorks Bridge Academy? Why would do you think the LifeWorks Bridge Academy would be beneficial to you? What desires do you have for being a part of the LifeWorks Bridge Academy?
