Project WILL Member Initial Application (Rev 2)

Project WILL Member Initial Application

Supp-Exp 1.2, Rev. 2, Date: 02/2025
Desired Program*

The LINKS InitiativeCamp WILLThe LAUNCH ProgramThe LINKS Initiative - FRESH START
The LAUNCH Program

The LAUNCH program is an innovative initiative designed to assist young adults ages 18-35 with an intellectual or developmental disability in effectively navigating the job search process and achieving sustainable career success. By concentrating on Learning new skills, Accessing resources, Understanding their rights and strengths, Networking with mentors, peers and potential employers, Creating tailored resumes and career plans, and Honing their skills for continuous improvement, this program adopts a comprehensive approach to workplace preparedness.

LAUNCH serves as the next step for participants transitioning from the LINKS initiative, once they are prepared to fully engage in the workforce. Additionally, individuals entering Project WILL who may be eager to commence their careers are also encouraged to apply.

Services may be provided through weekly 1:1 individual coaching or 4:1 group training.
The LINKS Initiative

The LINKS Initiative is a transitional day program designed for young adults aged 18-35 with an intellectual or developmental disability, focusing on six core areas: Self-advocacy, Teamwork, Workplace Preparedness, Social and Romantic Relationships, Financial Literacy, and Wellness. Our goal at LINKS is to foster a safe and culturally informed environment that promotes positive growth.

We believe each Member’s growth is fundamentally related to the 4 E’s of transformation: establishing realistic expectations, providing experiential learning opportunities through volunteer work, supporting our members in skill development for employment, and prioritizing their overall emotional well-being. Through collaboration with local nonprofits and faith-based organizations, The LINKS Initiative strengthens the capacity of mission-driven entities that may lack the resources to hire additional staff, while also offering our members valuable work experience.

Our systematic approach and process is to simply “LINK” classroom and community training activities to real-life experiences and future life goals.
Which LINKS Location

Northeast - 7168 Graham Rd suite 120, Indianapolis, IN 46250West - 2020 North Girls School Road, Indianapolis, IN 46214
The LINKS Initiative - FRESH START

The LINKS Initiative - Fresh Start is designed for young adults aged 18-35 who have an intellectual or developmental disability and have encountered significant behavioral challenges. Our program emphasizes six core areas: Self Advocacy, Teamwork, Workplace Preparedness, Social and Romantic Relationships, Financial Literacy, and Wellness.

While the focus on these six core areas remains consistent, this new initiative specifically targets individuals who may have faced legal challenges or exhibited behaviors that could potentially lead to involvement with the justice system. We aim to support those who are motivated to make life changes, build connections with supportive peers, and enhance their problem-solving and coping skills. We also welcome individuals who have experienced setbacks in the past but are ready to make better decisions moving forward.

Our commitment is to facilitate a safe and culturally sensitive environment that encourages positive growth. Classes are conducted at 1010 Central Ave, Indianapolis.
Camp WILL

Camp WILL is an 8-week summer enrichment program designed for youth ages 14–17 years old with an intellectual or developmental disability interested in career awareness. By learning about work, campers build awareness about careers and postsecondary options through experiences such as field trips, career days, professional speakers, and running their own businesses.

The program focuses on developing life and social skills while offering opportunities for career exploration and self-discovery. Camp WILL encourages youth to reflect on their identities and envision their future, fostering inquiries such as "Who am I?" and "Who do I want to be in 10 years?"

Throughout the summer, Campers will engage in activities that allow them to explore their interests, strengths, and build connections with their peers in an environment that promotes both discovery and enjoyment.
Which Camp Location

Northeast - 7164 Graham Rd, Indianapolis, IN 46250West - 2020 North Girls School Road, Indianapolis, IN 46214

Type of attorney

PrivatePublic DefenderN/A
Judge Name if applicable

First NameLast Name
Judge email
example@example.com
Judge office phone number
Please enter a valid phone number.
Prosecutor Name (if applicable)

First NameLast Name
Prosecutor Email
example@example.com
Prosecutor Phone
Please enter a valid phone number.
Parent/Guardian/Authorized Representative Information
Parent/Guardian/Authorized Representative Name*

First NameLast Name
Parent/Guardian/Authorized Representative Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Home Phone Number
Please enter a valid phone number.
Parent/Guardian Cell Phone Number*
Please enter a valid phone number.
Parent/Guardian Email*
example@example.com
Please upload a copy of guardianship paperwork.

Cancelof
As the applicant is their own legal guardian, please proceed by clicking 'Next' to continue to the next page.

Emergency Contact Infromation
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Relationship*

Medications
Will you need to take any medication during program hours:*

YesNo

Waiver Information
Case Manager Name*

First NameLast Name
Case Manager Phone Number*
Please enter a valid phone number.
Case Manager Email Address*
example@example.com
Company*
Please check all services you receive from other waiver providers*

Behavior Support ServicesEmployment Services (Vocational Rehabilitation or ExtendedServices)Musical or Recreational ServicesOccupational TherapySelf-Directed Services(Residential or Community Habilitation, respite, or PAC)
Name of Behavior Support Specialist
Name of Employment Specialist
Name of Music Therapist
Name of Recreational Therapist
Name of Occupational Therapist
Name of Agency

Behavioral Concerns

Please complete all that apply

	Describe Behavior	Frequency	How Long Since Last Episode
Aggression
Anxiety
Depression
Elopement
Physical Aggression
Property Destruction
Self-injurious
Self-stimulating
Sexual Inappropriate Behavior
Verbal Aggression
Previous Criminal Activity
Other

Additional comments regarding behaviors

Education
Name of School:
City, State
Highest Education Level Completed
Number of Years Attended
Teacher of Record/Transition Coordinator

Vocational Experiences

Please

	No	Yes	If yes, please describe
Paid Work
Unpaid Work

Desired Outcomes

What are you hoping to accomplish by participating in this program?

Goal 1

	Please complete
Goal #1
Objective #1
Objective #2

Goal 2

	Please complete
Goal #2
Objective #1
Objective #2

Goal 3

	Please complete
Goal #3
Objective #1
Objective #2

Additional Comments

The information in this document is confidential and will only be used by Project WILL, Inc. for application purposes. My signature verifies that all of the information is true and valid to the best of my knowledge.
Signature of Member

Clear
Member Signature Date
Signature of Parent/Guardian/Other Authorized Representative

Clear
Parent/Guardian/Other Authorized Representative Signature Date
Should be Empty:

	Yes	No
Is relatively free from signs of problems
Understands what is being said
Makes eye contact
Follows multi-step directions
Shows anger appropriately
Resists cooperation
Interacts appropriately with staff
Interacts appropriately with peers
Interacts appropriately with animals
Doesn't interact, even when encouraged
Appears to have significant emotional problems

	No	Yes	Describe
Utilizes public transportation
Adaptive equipment required while riding in vehicle
Special seating arrangements while riding in vehicles
Depends on others
Can schedule rideshare independently

Project WILL Member Initial Application

The LAUNCH Program

The LINKS Initiative - FRESH START

General Information

Applicant Information

Parent/Guardian/Authorized Representative Information

Emergency Contact Infromation

Medical Concerns

Medications

Waiver Information

Communication Skills

Behavioral Concerns

Social/Emotional Development

Transportation

Education

Vocational Experiences

Desired Outcomes

Additional Comments

	Medication Name	Dose	Time	Route
Medication
Medication
Medication
Medication
Medication
Medication