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CareerNext Application Form
Congratulations on your decision to apply to CareerNext or CareerNext CHOICE. CareerNext is a support service that provides personalized assistance to obtain a credited career certificate, associate or bachelor’s degree. In-person services are available to students enrolled at Hudson Valley Community College and SUNY Cobleskill. CareerNext CHOICE offers the same support services, at a distance, to students enrolled at other U.S. colleges and universities. In this application, you will be asked to submit the following documents: IEP/504 plan, Psychological or psychoeducational evaluation, most recent academic transcript. Please collect them now to have ready. You will be able to save this application throughout the process and return at a later time. If at any point you have questions regarding the application, please reach out to our admissions team. Peter Russo: peterrusso@livingresources.org, or 518-218-0000 ext. 5513 OR Morgan Mulroe: morganmulroe@livingresources.org, or 518-218-0000 ext. 5301.
Minimum Requirements for Admission
• Motivated to learn and participate in discussions and conversations with instructors and students •Motivated to independently complete in-class assignments and homework, and ability to independently follow a schedule •Ability to get along with others, follow code of conduct of the college and respective facilities •Ability to attend college courses without supervision. Students with Autism or documented learning differences who are looking to obtain an accredited certificate or degree are welcome to apply. Students must obtain admission to both CareerNext and the college. All students will be held to the academic standards and requirements of the college in order to maintain eligibility throughout the duration of the program.
Program Disclaimer
CareerNext and CareerNext CHOICE provide academic tutoring and executive functioning support while students pursue their degree. It is not a residential program. We DO NOT provide housing, mental health counseling, or medication management services.
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Applicant Information
Full Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Gender Identity
Please Select
Female
Male
Non-Binary
Gender Nonconforming
Other
Prefer not to answer
Date of Birth
*
-
Month
-
Day
Year
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Social Security Number
Example: 000-00-0000
Are you enrolled in the NY START Program?
Yes
No
How did you hear about CareerNext Services?
College or Transition Fair
Expo or Conference
Guidance Counselor
Care Coordinator
Educational Consultant
Friend/Family
CareerNext Website
Social Media
Newsletter
Other
If a friend or family referral, what is their relation to CareerNext?
Example: current student, graduate, friend of CN student, etc.
Photo of Applicant
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Parent/ Guardian Information
Name
*
First Name
Last Name
Parent/ Guardian Type
*
Please Select
Parent (Mother)
Parent (Father)
Guardian
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Occupation
Name
First Name
Last Name
Parent/ Guardian Type
Please Select
Parent (Mother)
Parent (Father)
Guardian
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Occupation
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College Enrollment
I will be applying to the College as a
Please Select
New Freshman Student
Transfer Student
Other
Anticipated Semester of Enrollment
Please Select
Fall
Spring
Summer
Anticipated Year of Enrollment
Which CareerNext Program are you interested in
*
SUNY Cobleskill
Hudson Valley Community College
CHOICE
Undecided
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SUNY Cobleskill
In Person Services
Intended Major
Degree Type
Please Select
Associates
Bachelors
Minor
Optional
Certificate
Optional
Have you received admission from the College?
Yes
No
Waitlisted
Other
If you are currently enrolled with the College, when did you begin courses?
Semester/Year (Example: Fall 2024)
Are you looking to live on campus or commute?
Live on campus
Commute
Undecided
If you are interested in living on campus, do you want to learn more and or apply for a housing accommodation?
Yes
No
Are you looking to attend the College with a service animal?
Yes
No
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Hudson Valley Community College
In Person Services
Intended Major
Minor
Optional
Degree Type
Please Select
Certificate
AA
AS
AAS
AOS
BA
Have you recieved admission from the college?
Yes
No
Other
If you are currently enrolled with the College, when did you begin courses?
Semester/Year (Example: Fall 2024)
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Other Accredited U.S. College or University (in association with CareerNext CHOICE)
College or University
Intended Major
Minor
Optional
Degree Path
Please Select
AA
AS
AAS
AOS
BA
Have you received admission from the College?
Yes
No
Waitlisted
Other
If you are currently enrolled with the College, when did you begin courses?
Semester/Year (Example: Fall 2024)
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Undecided
Intended Major
Minor
Optional
Degree Path
AA
AS
AAS
AOS
BA
If you are currently enrolled with the College, when did you begin courses?
Semester/Year (Example: Fall 2024)
Would you like an admissions counselor to reach out to discuss our different CareerNext program options?
Yes
No
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Personal Information
Formal Diagnosis
What are your strengths?
What areas do you struggle with?
Any history of, or current legal difficulties?
Yes
No
If yes, please explain
Have you ever been convicted of a misdemeanor or felony?
Yes
No
If yes, please explain and provide dates
Are you your own legal guardian?
Yes
No
If no, who is your legal guardian?
First Name
Last Name
Have you run away before?
Yes
No
If yes, please explain
Have you ever been hospitalized for psychological reasons?
Yes
No
If yes, please provide dates and reason for hospitalization
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Medical Information
Do you take medications?
Yes
No
Do you take these independently?
Yes
No
Mostly
Other
If no, please explain your medication management plan if selecting on-campus housing
Do you have a history of seizures?
Yes
No
If yes, please explain.
Do you take rescue medication for seizures?
Date of last seizure
-
Month
-
Day
Year
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Do you currently have counseling services?
Yes
No
If yes, frequency:
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Life at School
Name of High School Attended
Location of High School
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Year of Graduation
Type of Diploma Received / Anticipated
Did you or do you have a behavior support plan?
Yes
No
If yes, please attach
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What type of services did you receive in high school? Select all that apply.
Self-Contained Classes
Counseling
Adaptive Physical Education (PE)
Resource Room
Inclusion Classes
Occupational Therapy (OT)
Consultant Teacher
Speech
Physical Therapy (PT)
Other
Did you take the SAT / ACT?
Yes (SAT)
Yes (ACT)
No
If yes, what were your scores?
What was your favorite subject?
What was your least favorite subject?
What supports have you received in the past which you found beneficial?
What areas will you need extra help in?
What activities were you involved with in and out of school?
High School Transcript
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Life After High School
If you have attended any school, college or program after high school, please fill out information below.
Name of school, college, or program
Location
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Attended From-To Dates
Example: 2021-2024
If you attended any college, please answer the following:
Major
# of credits received
College Transcript
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Only if you have credits from another institution
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Reason for leaving or seeking CareerNext services
Did you dorm there?
Yes
No
If yes, any issues or concerns?
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Supporting Documents
IEP or 504 plan
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Most recent
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Psychological Evaluation
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Most recent, preferred within 3 years
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Referral Information
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to you
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Signature
By signing below, I certify all information is true and correct to the best of my knowledge. Omission of information or false reporting could lead to dismissal after admission
Applicant Signature
*
Date
*
-
Month
-
Day
Year
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