Vicksburg Community Schools

LINKS Application

Applicants Name:______
(Last) (First) (Current Grade)
D.O.B.______
(Student number)
Parent/Guardian: :______
(Last) (First)
Address:______
(Street) (City) (Zip)
Applicant’s Telephone:______
(Home) (Email Address)

Overview:

Autism is the fastest growing disability in the United States and affects 1 out of every 110 children. Vicksburg Community Schools has seen a growth in the number of students that have been identified with Autism Spectrum Disorder. By completing this application, you are indicating your desire to be considered for the LINKS program. If selected, you will be trained in strategies that are proven successful in working with students with Autism, as well as information on Autism Spectrum Disorder (ASD). When your application is complete, please turn it in to Ms. VanderKolk, Room 102 at VicksburgHigh School. During this time you will be asked to schedule a personal interview time with Ms. VanderKolk.

Student Section:

  1. Explain why you think you would like to work with students with Autism Spectrum Disorder as a mentor/tutor/LINK.
  1. What are you expectations for the LINKS program?
  1. Middle School students involved in this program will need to be positive role models for the students with ASD that they will be working with. Good attendance is crucial to the success of this program. Please rate your interests in the following areas:

Circle the Number That Best Describes Your Capabilities

Low High

Interest in helping students with disabilities 12345

Willing to learn mentoring skills 12345

Willing to learn new leadership skills 12345

Ability to pass on good study and social skills 12345

Good math skills12345

Knowledgeable in science12345

Good writing skills12345

  1. Teacher Recommendation ______

Print Name Signature

Applicant’s Signature:______Date:______
Parent/Legal Guardian’s Signature:______Date:______
I agree that this will be beneficial experience for______and
Support his/her involvement in this program.

Turn in your completed application to Ms. VanderKolk in Room 102, and schedule a time for a personal interview.