VisAbility ProMOTE Application

ProMOTE Application Form
I. Application Contact Information.

Please provide the required information in the space below each item.
First Name*
Last Name*
Home Street Address*
Home Street Address Line 2
City*
State*
Zip*
Home or Cell Phone*
Personal Email Address*
Date of Birth*
Emergency Contact*
Emergency Contact Number*

II. Applicant’s Work Information
YesNo
Job Title
Agency or Company Name
Department Name
Supervisor’s Name
Supervisor’s Email
Supervisor's Phone Number
Work Street Address
Work Street Address Line 2
City
State
Zip
Work Phone
Work Email Address

IV. Applicant Background and Readiness

For the eleven essay questions, please provide your response in the section below.
1. Why do you want to participate in ProMOTE?*
2. Have you participated in any of the following: college classes, educational seminars, multi-day training, etc.? If so, please describe. *
3. Explain how your experiences and interests make you a good candidate for this program.*
4. What are your short-term (2 to 5 years from now) career goals? How do you see utilizing the skills you acquire in the ProMOTE course in your professional life?*
5. Please describe your use and your proficiency level with Microsoft Word, Excel, Outlook, and Power Point in your current job and/or in your personal life.*
6. What assistive technology do you use to read, work on a computer, and navigate the internet? Please state what ZoomText magnification level(s) you use. *
7. Have you received any training on the use of your assistive technology within the last year? If yes, please describe the training and its duration.*
8. What browser do you use and for what purposes?*
9. Please describe your typing skills by answering the following questions:
a. How long does it take you to type a fifteen word sentence?*
b. What keys would you press to input the @ symbol?*
c. Do you use and are you comfortable using modifier keys i.e. Control, Alt, and Shift to perform various functions in Windows and Office programs?*
10. Describe your learning style by addressing the following questions:
a. Do you like to work alone or with partners or groups?*
b. Are you a listener or do you like to express your opinions?*
c. Do you accept feedback and constructive expressions regarding your work?*
d. Do you enjoy large assignments and how do you approach them?*
e. Do you prefer shorter tasks?*
f. Describe any other descriptions of your work/study habits*
11. Describe a way you have shared skills you already have with a co-worker, peer, or manager.*

Type in your name to verify the following information*
V. Resume

Your application submission must include your resume. Please send to flagana@visability.org with your name in the subject line.
VI. Letter of Recommendation

Email a letter of recommendation to flagana@visability.org with your name in the subject line.
VII. Application Verification

I have read, fully understand the expectations, meet the eligibility requirements, and have completed this application form myself.
VIII. Submitting Your Application

To be considered for ProMOTE, VisAbility Pittsburgh must receive all completed materials by the application deadline.

a. Application Form

b. Applicant’s Professional Resume

c. Recommendation Letter

If you have questions, please contact Francesco Lagana, by phone 412.368.4400 or email flagana@visability.org
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ProMOTE Application Form

I. Application Contact Information.