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2009 Summer Institute Application

Fri, 2008/05/09 - 06:17 — ppatel

this application gathers important data for individuals wishing to attend the PeopleTech Summer Institute. * indicates a required field. See our contact information if you have trouble filling out the this application.

If you are using JAWS, only enter forms mode when necessary. You will only need to enter forms mode for fields where you need to type or choose an item from a combo box. Checkboxes and radio buttons can be selected without entering forms mode. We also suggest that you use your arrow keys to read the labels associated with the form fields. Avoid using the tab key to move from field to field.

Personal Information

Personal Information

Please provide the date of your birth

Please choose your ethnicity

Please select whether your primary language is English

CCVIP and Summer Institute Background

Are you applying to CCVIP for the first time?

Education and Employment Background

For the questions below, please provide answers about your current educational status and answer questions about your employment history.

Please enter the last dae on which you attended classes

disability and technology

For the questions below, please provide information related to your disability and your experiences with technology.

Describe your disability and how it effects you. For example, you can tell us about your site loss, whether its partial or complete, or how you are able to function. Your description can include other disabilities such as a learning disability.

Write your answer in terms of words per minute

Please tell us howyou take notes (i.e., someone else takes note for you, by using a PDA, etc.).

Adaptive hardware and software may include screen reders, screen magnifiers, reading systems such as kurzweil 1000 and 3000, Open Book and Wynn, note takers, PDA's, etc.

Examples may include Microsoft office, Windows, etc.

Examples may be: 10 months, two years, 10 years, etc.

Miscellaneous
Agreement and Certification

I hereby certify that all information provided on this page is accurate and complete. I have read the PeopleTech privacy policy and the terms for participation in the summer institute. I understand that the PeopleTech project team will track my academic and social progress at CUNY to gain further understanding of the effectiveness of this training.

Please enter your full name. This electronic signature will serve as your agreement.