2021 STEPS to Success

What is the VRCBVI STEPS to Success program? VRCBVI’s STEPS to Success (Strategies & Techniques for Enhancing Performance & Skills) is a three-week virtual collaborative program between the University of Richmond’s School of Professional & Continuing Studies and the Virginia Rehabilitation Center for the Blind and Vision Impaired (VRCBVI). Our innovative program introduces valuable skills, techniques, and strategies to help maximize success in preparing for college or careers. This year, we are pleased to make this program available to more students by offering a virtual program. Specialized classes taught by highly experienced and enthusiastic teachers include: • Common Application and Supplemental Essay Writing • Preparation for the English portion of the S.A.T. test • Standardized Test Taking Tips • Self-advocacy in college and career • Public speaking • Interviewing techniques • Leadership • Time-management and mindfulness • Selecting colleges/career paths Attending the VRCBVI STEPS to Success program will give rising high school juniors and seniors and high school graduates from spring 2021 the opportunity to assess their college-readiness skills, enhance awareness of the academic and blindness-related demands of college, and evaluate their ability to manage time and priorities. Dates to Remember: • Application Deadline: Friday, April 30, 2021 • Classes begin July 5, 2021 • Closing Ceremony: Friday, July 23, 2021 - 11:00 a.m. to 1:00 p.m. Requirements for the VRCBVI STEPS to Success Program: • Be blind or vision impaired • Be a rising junior or senior in high school in the fall of 2021 or a spring, 2021 high school graduate planning to attend college • Have reliable internet access • Have during the STEPS program a laptop, Mac or Chromebook with appropriate access technology (JAWS, Zoomtext, or equivalent) and working audio/video to participate in virtual classes and complete assignments • Have an existing personal e-mail account (Gmail, Yahoo, AOL, etc.) • Have a method for taking written notes during class • Be able to participate fully in all three weeks of the virtual program • Be able to participate in a program that is group structured • Have an open or be willing to open a Vocational Rehabilitation case with Department for the Blind and Vision Impaired (DBVI) What is the application process for the VRCBVI STEPS to Success program? The following steps must be completed by the April 30, 2021 deadline: 1. Complete the online VRCBVI STEPS to Success application below (upon completion, you will receive a confirmation email indicating that step 1 of your application has been received) 2. Submit transcripts documenting GPA of 2.5 or above (unofficial transcripts are acceptable) to Brooke Rogers (see mail, fax and email info below) 3. Submit two letters of reference (one must be an academic reference) to Brooke Rogers (see mail, fax and email info below) 4. Print the DBVI Eye Exam Report and have it completed by a medical professional (must be dated not more than one year prior to the VRCBVI STEPS to Success application deadline).* Once completed, please send to Brooke Rogers (see mail, fax and email info below). *If a student attended a summer program at VRCBVI in the past, the eye exam report form submitted for that program are acceptable, provided the parent(s) submit a statement that the student’s eye report information has not changed and is still accurate. Please mail, fax or email the above to: Address Virginia Rehabilitation Center for the Blind and Vision Impaired ATTN: STEPS - Brooke Rogers 401 Azalea Ave. Richmond, VA 23227 Email brooke.rogers@dbvi.virginia.gov Fax (804) 371-3092 Program Feedback STEPS to Success Feedback Feedback will be provided to students and parents after the completion of the program. Students will be able to meet by teleconference with their Vocational Rehabilitation Counselor, designated VRCBVI staff, and parents to discuss assessment results and recommendations. Hurry! Applications will only be accepted until midnight on April 30, 2021. • After April 30, complete applications will be reviewed and final decisions on acceptance will be made by May 14. • If the applicant has a DBVI VR counselor, he/she will be notified of the applicant’s acceptance into VRCBVI STEPS to Success program, and the counselor must complete and submit a DBVI Service Authorization. • Upon acceptance into the VRCBVI STEPS to Success program, students will receive a VRCBVI welcome packet, which provides additional information regarding the virtual class schedule as well as required forms which must be signed and returned by June 18, 2021, in order to confirm acceptance. For additional information, contact: Amy Phelps, Assistant Director for Instruction amy.phelps@dbvi.virginia.gov Phone: (804) 371-3052

Student Information

Student's first name: Student’s Name:

Student's last name:

Grade (Fall, 2021): Grade Fall 2021

rising high school junior rising high school senior high school graduate (Spring 2021)

Date of birth (mm/dd/yyyy): Date of birth (mm/dd/yyyy):

Student's age at application:

Street address: Mailing Address:

City:

State:

Zip code:

Physical Address (if different from mailing address):Physical Address if different

Student's cell number. Please enter NA if student does not have a cell phone: Student cell number

Student’s email address (Student must have working email address to participate in the STEPS to Success program - this is where all program information will be sent, so please enter carefully):Student email address

Cause of blindness:Cause of blindness

Visual acuity: Visual acuity

Field of vision: Field of vision

Describe any adjustment to blindness issues:Adjustment to blindness issues

Does the student have an open case with the Virginia Department for the Blind and Vision Impaired (DBVI)? Case with DBVI

Yes No

If yes, please provide the rehabilitation counselor’s or education coordinator’s name here:DBVI counselor name

Will you have reliable internet access during the STEPS to Success program? Internet access

Yes No

Will you have during the STEPS program a laptop, Mac or Chromebook with appropriate access technology (JAWS, Zoomtext, or equivalent) and working audio/video to participate in virtual classes and complete assignments? Equipment confirmation

Yes No

What are the student’s goals for attending the STEPS to Success program?Student goals

Is there anything else the student wants the VRCBVI and the University of Richmond staff to know?Anything else

Parent / Guardian Information

Parent/Legal Guardian Name(s):Parent or Guardian Name

Parent/Legal Guardian Address:Parent Guardian Address

Parent/Legal Guardian phone number and corresponding name (Cell #1):Parent Guardian Phone 1

Parent/Legal Guardian phone number and corresponding name (Cell #2):Parent Guardian pone 2

Parent/Legal Guardian phone (Home):Parent Guardian Phone Home

Parent/Legal Guardian phone number and corresponding name (Work):Parent Guardian Phone Work

Best time of day to contact:Best time to contact

Best person/ number to contact (cell, home or work):Best person and number to contact

Parent/Legal Guardian email address (this is where all program information will be sent so please enter carefully):Parent Guardian email address

Corresponding name to email address listed above:

Student Medical Information

Does the student have other disabilities in addition to blindness?Does the student have other disabilities in addition to blindness?

Yes No

If yes, list other disabilities here: list other disabilities

Does the student have any psychological or emotional disabilities?Psychological or emotional disabilities

Yes No

If yes, briefly describe the psychological and/ or emotional issues:Describe psychological emotional

Does the student have any chronic medical condition(s) that requires a management plan, such as diabetes, asthma, migraine disorder, seizure disorder, anxiety, etc.?Does the student have any other chronic medical condition(s) that require a management plan, such as asthma, migraine disorder, seizure disorder, anxiety, etc.?

Yes No

If yes, please list the chronic medical diagnosis and the established prevention plan (such as: uses an inhaler with exertion, requires extra time to orient to new situations, requires rest in a quiet room when experiencing migraine symptoms, needs to stay hydrated to prevent seizures, etc). If you do not have a plan would you like the Health Educator to reach out to you?list prevention plans

Emergency Contact Information

Emergency contact name, phone number and relationship to student (not provided above):Emergency contact info

If you are student’s legal guardian, do you have a copy of the court documents demonstrating that? Legal guardian documents

Yes No N/A

If yes, please fax a copy of the legal guardianship court order to VRCBVI, Attention: Brooke Rogers at (804) 371-3092. If no, please explain:Please fax or explain

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 STEPS to Success program must be signed by both parents.

______ and ______ have joint legal custody of student. (please provide names)Names of legal custody providers

I have sole legal custody of applicant (please provide name): sole custody of applicant

Signatures

Please sign below to indicate that you have read all of the above and are able to fully participate in all of the virtual VRCBVI STEPS to Success Program activities.

Student Signature:Student Signature

Custodial Parent/Guardian Signature:Parent Guardian Signature