NNL Recommendation from a Teacher, Counselor, Administrator, or Coach

This form is part of the application packet for the Neuroscience for Neurodiverse Learners (NNL) Program. To learn about the other components of the program, visit the Summer Program��貹��.

You can also access the full��application��in Spanish, Russian, or Vietnamese.

Instructions: A teacher, counselor, administrator, or coach must complete the form below and the short essay questions.

All NNL program offerings are contingent upon receipt of continued funding. All��participants are required to be citizens��or��permanent residents of the United States or its possessions. The ��ԭ�� reaffirms its policy of equal opportunity regardless of race, color, creed, religion, national origin, sex, sexual orientation, age, marital status, disability, or status as a disabled veteran, or Vietnam era veteran in accordance with University policy and applicable federal and state statutes and regulations.

View UW and DO-IT’s Privacy Practices for Youth Programs here: English�� | | | | |

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First Name *

Last Name *

Position/Title

Phone *

Please use the format XXX-XXX-XXXX

Email *

Student applicant's First Name *

Student applicant's Last Name *

High School Name *

School Address1 *

School Address2

School City *

School State *

School Zipcode *

��ԭ�� Applicant

Grade level, current academic year *

How much time do you spend with the student per week? *

Applicant’s disability *

Percentage of the applicant’s time spent in Specially Designed Instruction (SDI)? *

Indicate academic area of SDI *

Respond to each of the questions below. ��You may enter text in the field provided or upload a single alternative file,��if needed. Your honest and thorough assessment of this applicant is helpful.

1. What is the nature of the student’s disability and how does it affect them academically? *

2. What types of accommodations and supports does this student use at school presently? *

3. What academic and social support are they receiving to promote their success as they transition toward college? *

4. Please comment on this student's potential to participate in postsecondary education. *

5. Please comment on why you think this student is a good candidate for a STEM program. *

6. Additional comments (optional).

File Upload (alternative format for Questions 1-6)

10 MB size limit
Files must be less than 10 MB.
Allowed file types: txt rtf html pdf doc docx ppt pptx xls xlsx xml avi mov mp3 ogg wav.

Leave this field blank

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