High School Teacher, Administrator, or Counselor Recommendation

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This form is part of the application packet for the DO-IT Scholars program. Application packets must be complete before they can be reviewed. To learn about the other components of the application package, see Applying.

Instructions: A teacher, counselor, or administrator must complete the form below and the eight essay questions. If you prefer, you can print this form and submit it to DO-IT by postal mail, fax, or email. You can also access the full application in Spanish, Russian, or Vietnamese.

Deadline: January 30th. Applications for the upcoming summer are accepted throughout the school year; however, priority is given to applications received by January 30th. Applications received after January 30th will be considered on a space available basis.

All DO-IT Scholars program offerings are contingent upon receipt of continued funding. All DO-IT Scholar participants are required to be residents of Washington State. The University of Washington 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.

About You

First Name *

Last Name *

Position/Title

Address1 *

Address2

City *

State *

Zipcode *

Phone *

Please use the format XXX-XXX-XXXX

Email *

Student applicant's First Name *

Student applicant's Last Name *

High School Name *

District number *

School Address1 *

School Address2

School City *

School State *

School Zipcode *

About 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. How have they grown in their academic achievement since coming to high school? *

5. Please comment on this student’s academic interests. *

6. Please comment on this student’s potential to complete a college program. *

7. Please comment on how this student works in group learning environments. *

8. Please comment on this student’s computer skills. *

9. Please comment on why you think this student is a good candidate for the DO-IT Scholars program. How would they benefit from this program as described in the DO-IT Scholar brochure? *

10. Additional comments (optional).

File Upload (alternative format for Questions 1-10)

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.

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