Broward College Seahawk NEST Application

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Seahawk NEST(Navigating Education for Student Transition) is a 3-year program for students with intellectual disabilities offered at Broward College's North Campus and Judson A. Samuels South Campus. Students who successfully complete the program will earn a Broward College Professional Certificate.

Applicant Information

First Name:

Last Name:

Address:

City:

State:

Zip:

Phone Number:

Email Address:

Birthday:

Race

Hispanic/Latino

Gender

Name of High School

Date of graduation

Type of diploma graduated with:

Standard Diploma via Access Points

Standard Diploma

Certificate of Completion

GED

Other

If you answered other, what type is it?

Have you ever been previously enrolled at Broward College

Yes

If you answered Yes what program did you attend?

Do you have an intellectual disability?

Yes

Are you a client of Vocational Rehabilitation (VR)?

Yes

If you answered No would you be willing to become a VR client?

Yes

N/A

If you answered Yes who is your VR counselor?

Are you your own guardian?

Yes

If you answered no, who holds your guardianship?

Please upload a copy of the court documents here:

Parent/Guardian Information

What is your relationship to Applicant?

Parent

Legal Guardian

Other

Parent/Guardian First Name:

Parent/Guardian Last Name:

Parent/Guardian Phone Number:

Parent/Guardian Email Address:

Parent/Guardian Address:

City:

State:

Zip:

References

List 2 refences that have submitted a letter of refence for you.

Full Name, Relationship to you, and Email Address

Previous Employment/Volunteer Experience

What company did you work/volunteer with:

Supervisor Name:

Dates worked:

Start:

End:

Hours per week:

Work Responsibilities:

What company did you work/volunteer with:

Supervisor Name:

Dates worked:

Start:

End:

Hours per week:

Work Responsibilities:

Living Situation & Transportation

Where do you live?

on my own

with family/guardian

group home

with friends

What transportation will you use the most to get to campus?

Self

Family/Guardian

Public Transportation

Transportation Services

Goals & Programs

Which program of study within the Seahawks NEST program are you most interested in?

Business Pathway - Office Support focus

Business Pathway Guest Service Specialist focus

Education Pathway - Early Childhood focus

Industry, Management, Construction and Transportation - Machinist focus

Arts and Humanities - Graphic Design focus

Computer Information Technology – Information Technology Support Specialist

Computer Information Technology – Computer Programming & Analyst

Disclaimer & Signature

By typing your name below you certify that your answers are true and complete to the
best of your knowledge.

If this application leads to my acceptance, I understand that false or misleading
information in my application or interview may result in my release.

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