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VRCBVI 2021 LIFE “Learning Independence, Feeling Empowered!” Program Application
Dear LIFE 2021 Applicant and Family:
Thank you for your interest in the LIFE summer program at the Virginia Rehabilitation Center for the Blind and Vision Impaired (“VRCBVI”). We are excited to offer an interactive blindness skills training program, a real-world work experience, and vibrant confidence building activities this summer.
Requirements to participate in the 2021 LIFE Program:
If you meet the following requirements, please complete and submit the application packet to VRCBVI. By submitting an application, you acknowledge that you meet all required criteria.
Applicants must:
• Be able to actively participate in all five weeks of the program (unless returning to school)
• Be between 14 and 18 years old and be returning to a high school academic program in the fall of 2021 (14 years old on or before July 11 and must not turn 19 years old before August 13)
• Be blind or vision impaired and interested in acquiring blindness skills
• Be able to participate in group structured classes and activities
• Be able to take care of personal care needs independently, including managing and self-administering medications
• Have a valid government issued photo ID
• Have an open or be willing to open a Vocational Rehabilitation case with DBVI
Application Check List:
All applications must include the following documents: (Only complete applications submitted by the deadline will be considered.)
1) VRCBVI LIFE 2021 Student Application form (see below)
2) DBVI Health Checklist/General Medical Examination completed by a medical professional and dated no more than one year prior to the LIFE application deadline date of May 8, 2021. If a student attended a summer program at VRCBVI in the past the health form submitted for that program is acceptable, provided the parent(s) submit a statement that the student’s 2021 health information has not changed and the form is still accurate.
3) DBVI Eye Exam Report completed by a medical professional and dated no more than one year prior to the LIFE application deadline date of May 8, 2021. If a student attended a summer program at VRCBVI in the past, the eye report form submitted for that program is acceptable, provided the parent(s) submit a statement that the student’s 2021 Eye Exam Report information has not changed and the form is still accurate.
4) Copy of the student’s current IEP
Acceptance Status: After the application deadline, May 8, 2021, all complete applications will be reviewed. All applicants will be notified by May 29, 2021 of their acceptance status. A maximum of 15 applicants will be accepted to the 2021 LIFE Program. If the applicant is accepted into the program, we will send you a VRCBVI LIFE Welcome Packet which includes liability waivers and activity forms that you will be required to complete, sign and return to VRCBVI. The return deadline for forms and waivers will be provided in the LIFE Welcome Packet.
If, after the applicant has been accepted into the 2021 LIFE program, he/she decides to cancel participation, please contact Amy Phelps, Assistant Director for Instruction at 804-371-3052 or Amy.Phelps@dbvi.virginia.gov so that students who are on the waiting list can be scheduled.
Important Information to Remember:
Deadline for Application: May 8, 2021. NO APPLICATIONS FOR THE 2021 LIFE PROGRAM WILL BE ACCEPTED AFTER THIS DATE. Only complete applications will be considered.
Dates of Program: The five week program begins Sunday, July 11, 2021 at 1:00, and will end on Friday, August 13, 2021, at noon.
Attendance Requirements: Because this program is short and concentrated, we require that students who are accepted attend all five weeks. The only exception to this requirement is for students who are starting back to school during the last week of the LIFE program. If this is the case for the applicant, please attach documentation of when the student will be starting school. All students must participate in weekday classes (8:15 - 5:00) and evening (6:00 p.m. - 8:00/9:00 p.m.) and Saturday confidence building activities.
Additional questions: For additional information about the LIFE Program, or to participate in a LIFE Program FAQ session (6pm to 7pm on March 2 or April 1) please contact Amy Phelps by phone (804-371-3052) or email Amy.phelps@dbvi.virginia.gov or refer to the flyer on our website, VRCBVI LIFE. If you have questions about the application process, please contact Brooke Rogers, Assistant Director for Administration, at (804) 371-3151, or by email at Brooke.Rogers@dbvi.virginia.gov.
**If the 2021 LIFE Program is unable to proceed in-person, it will take place virtually. Parents and students will be notified as soon as possible.
We are looking forward to a great summer! Hope to see you soon!
Amy Phelps, Assistant Director for Instruction
Virginia Rehabilitation Center for the Blind & Vision Impaired
401 Azalea Avenue
Richmond, Virginia 23227
Phone: (804) 371-3052
Fax: (804) 371-3092
Facebook: VDBVI
Website: VRCBVI
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LIFE 2021 Student Application
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Will the student be able to attend all 5 weeks of the program?
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Parent / Guardian Information
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Student Medical Information
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Does the student have other disabilities in addition to blindness?
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Does the student have any psychological or emotional disabilities?
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Does the student have any physical limitations or activity restrictions?
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Does the student have diabetes?
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Does the student have any other chronic medical condition(s) that require a management plan, such as asthma, migraine disorder, seizure disorder, anxiety, etc.?
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If needed, please list any additional, pertinent information about student's medication administration here:
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Does the student have any medically-prescribed dietary needs, such as renal diet, celiac diet?
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Additional Student Information
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Does the student have an open case with the Virginia Department for the Blind and Vision Impaired (DBVI)?
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Does the student have any previous work experience?
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Emergency Contact Information
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If you are student’s legal guardian, do you have a copy of the court documents demonstrating that?
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If the parents have joint custody, please fax the court custodial order to VRCBVI, Attention: Brooke Rogers at (804) 371-3092.
If the student’s parents have joint custody of the student, all forms and documentation pertaining to the LIFE program must be signed by both parents.
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______ and ______ have joint legal custody of student. (please provide names)
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Student Learning Contract
VRCBVI LIFE 2021 promises to be a worthwhile experience for students who take advantage of the opportunities offered. To maximize learning, we have identified expectations to ensure a safe, productive summer. We ask that parents and students review the following.
Students will:
1. Never leave the facility without an adult (parent, approved family/friends, or staff).
2. Be responsible for telling the Center Case Manager or Administration about any problems.
3. Treat all students and staff with courtesy and respect.
4. Only gather with other students in approved common areas.
5. Use a cane at all times.
6. Understand that he or she will be using sleepshades as a learning tool during classes and occasionally during evening and weekend activities, as requested.
7. Not use cell phones during instructional times or during VRCBVI scheduled activities.
8. Not use tobacco products or illegal substances (drugs or alcohol).
9. Actively participate in all aspects of the program, including evening and weekend activities.
10. Exhibit behaviors that promote a positive learning environment free from bullying, threats, destruction of property or interference with the learning environment.
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Please sign below to certify that you have read, understand and agree with the student expectations. Failure to follow these policies can result in dismissal from the program.
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