PDF ver Project SEARCH Application

2026/2027 Project SEARCH Program Application

for Berrien County & Corewell Health in St. Joseph, MI
Application Deadline:
Friday, March 20, 2026

IMPORTANT INSTRUCTIONS!

Students may receive help from their Parent/Guardian or teacher.

1. Complete the application as fully as possible.

2. PRINT it and give it to the Student's Special Ed Teacher OR Parent/Guardian to complete their section.

3. Return to Berrien RESA
Attn: Julie Hess, Transition Coordinator
711 Saint Joseph Avenue
PO Box 364
Berrien Springs, MI 49103
STUDENT INFORMATION
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
Please use your personal/home email if you have one.
Birth Date*
MM/DD/YYYY
Benton HarborBerrien SpringsBrandywineBridgmanBuchananColomaEau ClaireLakeshoreNew BuffaloNilesRiver ValleySt. JosephWatervliet
Benton HarborBerrien RESABerrien SpringsBerrien Springs Virtual AcademyBrandywineBridgmanBuchananColomaEau ClaireHomeschoolLakeshoreNew BuffaloNilesPrivate/ParochialRiver ValleySt. JosephWatervliet
YesNo
If you answered "No", what is your Legal Guardian's name and relationship to you?
YesNo
If you answered "Yes", where and what days & hours will you be working?
Why do you want to participate in Project SEARCH? (If someone is helping you, please answer using the student's own words.)*
I am aware of and approve the following:
1. Release of Records: The student's educational and/or employment records concerning my son/daughter will be accessed by Berrien RESA.
2. Equal Opportunity: Project SEARCH placement will be made without regard to race, color, age, sex, national origin, cultural or economic background, or housing circumstances and is entitled to equal opportunity for educational development.
Student's Signature*
Date Signed*
MM/DD/YYYY
STUDENT'S WORK EXPERIENCE

Please list any jobs that you do OR have done at school, in the community, or at work.
Company / Organization #1
Supervisor's Name
Phone Number

Area CodePhone Number
List any duties that you performed.
Company / Organization #2
Phone Number

Area CodePhone Number
Supervisor's Name
List any duties that you performed.
YesNo
If "Yes", please explain...
YesNo
If "Yes", please explain...
SERVICES & SUPPORTS for the STUDENT
Michigan Rehabilitation Services (MRS)Michigan Bureau of Services for Blind People (BSBP)Riverwood CenterVocational Rehabilitation CounselorOther
MobilityFunctional reading at workReading comprehensionSpeech/LanguageHandling money/TransactionsCommunicating/Working with othersInterpreting/Responding appropriately to othersUnderstanding acceptable level of personal interactionAttendanceSelf-care/HygieneMedicinal self-administrationSelf-directionConfused/DisorientedDistractibleSubstance abuseMoodAttentionHyperactivityViolent behaviorHarming self or othersWithdrawal/IsolationBullyingDecision MakingAdjusting to new situationsTheftRecalling instructionsWork tolerrance (standing, stairs, lifting)Personal needs on the job
YesNo
REFERENCES
FAMILY Reference*

First NameLast Name
Relationship to the Student*
Phone Number*

Area CodePhone Number
Email*
SCHOOL Reference*

First NameLast Name
Title*
Phone Number*

Area CodePhone Number
Email*
COMMUNITY / OTHER Reference*

First NameLast Name
Title*
Phone Number*

Area CodePhone Number
Email*
PARENT / GUARDIAN INFORMATION
Parent / Guardian Name*

First NameLast Name
Parent / Guardian Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent / Guardian Phone Number*

Area CodePhone Number
Parent / Guardian Email*
I am aware of and approve the following:
1. Release of Records: The student's educational and/or employment records concerning my son/daughter will be accessed by Berrien RESA.
2. Equal Opportunity: Project SEARCH placement will be made without regard to race, color, age, sex, national origin, cultural or economic background, or housing circumstances and is entitled to equal opportunity for educational development.
Parent/Guardian's Signature*
Date Signed*
MM/DD/YYYY
SCHOOL / SPECIAL EDUCATION STAFF

This section is for the school to fill out.
Student's Total Credits to Date*
Student's Cumulative GPA*
YesNo
Number of days absent last school year?*
Number of days absent this current school year?*
Comments About the Student's Attendance
Please share any additional info you believe would be helpful for our committee to know about the student. Ex: strengths, needs, attitude, etc.
Copy of Shot/Immunization RecordsCurrent Individual Education Program (IEP) including Transition GoalsCurrent Evaluation Team Report (include most recent math & reading scores/levels)High School TranscriptSchool Transcript from any Other Formal TrainingAttendance RecordWork-based Learning Experience Evaluation
Should be Empty:

2026/2027 Project SEARCH Program Application

STUDENT INFORMATION

STUDENT'S WORK EXPERIENCE

SERVICES & SUPPORTS for the STUDENT

REFERENCES

PARENT / GUARDIAN INFORMATION

SCHOOL / SPECIAL EDUCATION STAFF