Beyond Access Application Beyond Access (BA) is a fee for service program that offers students resources, strategies, and technologies to enhance their learning experience. All students enrolled in BA will be involved in the design of their own program and can choose to focus on building a variety of learning and social skills based on their individual, academic, and personal goals. Student InformationStudent Name* First Last Cell Phone*Preferred Email* Enter Email Confirm Email Parent/Guardian(s) Names* Parent/Guardian(s) Email Address* Enter Email Confirm Email How did you find out about the Beyond Access program? Website Word of Mouth CSD’s Brochures UConn Faculty/Staff CSD Employees High School Counselor/Advisor Personnel at another college or university Conferences or Workshops College Transition Publications (ex: Princeton Review, Kaplan) Other If you are a student with a disability, how would you explain your disability to others?*What are your expectations of Beyond Access? What do you hope to get out of the program?*How would you describe your learning style (How do you learn best)?*AcademicsBased on previous experiences what are your academic strengths and challenges?*What learning strategies (study methods) have worked or not worked for you in the past?*Academic areas you would like to focus on: Goal Setting HW Assignments Memory and Concentration General study methods Class Participation Presentation Skills Notetaking Strategies Reading Strategies Learning Style Writing Strategies Research Strategies/Using Library Interacting with Faculty Math Strategies Major Exploration Test-taking Strategies College SkillsBased on previous experiences, what do you identify as your strengths and challenges as it relates to college skills?*Please see the box below if you are unsure of the categories that fitWhat (if any) learning strategies (study methods) have worked (strength) or not worked (challenges) for you in the past?College skills you would like to focus on: Self Determination/Self Advocacy Self-monitoring strategies Stress Management Extracurricular Involvement Transition to College Communication Skills Time Management Organization Strategies Self Awareness Health and Wellness Social Interaction Disability Awareness Career Exploration (Careers, Resume, Internships, Networking, Disability Disclosure, Interviewing etc.) Residence Hall Living Learning TechnologiesLearning technologies are known as “any technology used to increase, maintain, or improve the academic functional capabilities (e.g., studying, listening, planning, organizing, reading) of students.” (AT definition)Are you currently using any learning technologies?*YesNoIf Yes, what?What technologies (apps, computer, software programs, smart phone, tablet, etc.) do you currently utilize?*What are some ways you utilize technology to help you with your academic and social obligations?*Please check off areas you would be interested in learning more about below: UConn Web-based programs (Husky CT, PeopleSoft, etc.) Email (etiquette, communication, etc.) Apps/software specific to disability Learning technologies specific to: Reading Writing Notetaking Study strategies Website navigation Organization and Time Management Stress Management Programs for specific content areas (math, science, English, second language, etc.) Other If selected Other, please specify:Any additional information you would like to share with us:AdditionalPOLICY REGARDING CONFIDENTIALITY AND MAINTENANCE OF RECORDS The Family Educational Rights and Privacy Act of 1974 (FERPA), as amended, is a federal law that affords students certain rights regarding their education records. Education records is broadly defined as those records, files, documents and other materials that contain information directly related to a student and are maintained by the University. For the purposes of FERPA, the University considers all students to be independent. Therefore, educational records will not be provided to parents without the written consent of the student. For additional information regarding FERPA, please refer to UConn's FERPA Website. If you are a student with a disability and have provided medical documentation to the CSD, please note the following: The Center for Students with Disabilities (CSD) is the University agent charged with the responsibility for collecting and maintaining disability documentation. Documentation provided to the CSD is confidential and only shared with others with the expressed written permission of the student. All documents submitted to the CSD are scanned, stored, and maintained in the Center’s electronic case management system, which includes information about student demographics, academic programs, documentation of the disability, accommodations, and student contacts with the CSD. The CSD electronic case management system is hosted on a secure server and is developed using industry best practices. Access to the system and its information is limited to CSD personnel only. Once student documents are scanned and uploaded to the system, paper copies are immediately shredded. Information will only be shared within the institutional community if there is a compelling reason, such as a threat to an individual's safety and/or emergency situation. Consent of the student will be requested prior to releasing medical/psychological documentation to a third party. Confidentiality is not maintained in the case of child abuse, suicidal or homicidal intent. AUTHORIZATION FOR INFORMATION RELEASE* I make the following authorizations regarding the release of information pertaining to me for the purpose of assisting me in my program, as well as in determining reasonable accommodations (if applicable). If applicable, I permit the CSD to contact my current treating physician, psychiatrist, etc. to further discuss and/or obtain additional information regarding the nature of my medical condition, medical records and history of treatment.*AuthorizeDo Not AuthorizeN/AI permit the CSD to discuss academic, medical or personal information with my parents, guardians and/or designated family member(s).*AuthorizeDo Not AuthorizeN/AIf any exceptions apply to these authorizations, please indicate them below:* I understand that these authorizations may be withdrawn by me at any time through a written, signed and dated request or in conference with a CSD professional staff member.