Parent/Guardian Recommendation and Consent Neurodiverse Learners (NNL) Program

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This form is part of the application packet for the Neuroscience for Neurodiverse Learners (NNL) Program. To learn about the other components of the program, visit the Summer Program page.

You can also access the full application in Spanish, Russian, or Vietnamese.

Instructions: A parent or guardian must complete the form below and the short essay questions.

All NNL program offerings are contingent upon receipt of continued funding. All participants are required to be citizens or permanent residents of the United States or its possessions. 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.

Student applicant's name *

Primary Parent/Guardian Contact Information

Name of parent/legal guardian *

Telephone *

Please use the format XXX-XXX-XXXX

Email *

2nd Parent/Guardian Contact Information

Name of parent/legal guardian

Telephone

Please use the format XXX-XXX-XXXX

3rd Parent/Guardian Contact Information

Name of parent/legal guardian

Telephone

Please use the format XXX-XXX-XXXX

4th Parent/Guardian Contact Information

Name of parent/legal guardian

Telephone

Please use the format XXX-XXX-XXXX

1. Explain why you consider the applicant a good candidate for the NNL Summer Program *

2. What are your student applicant’s greatest strengths? *

3. What types of accommodations and supports are helpful to your student applicant? *

4. Is there additional information regarding the applicant that would be useful to DO-IT Staff?

Approval

Please give approval for (applicant) to participate in the Neuroscience for Neurodiverse Learners (NNL) Student Program. *

I do

Leave this field blank