Clone of Clone of Project SEARCH Application

2026/2027 Project SEARCH Program Application

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

IMPORTANT INSTRUCTIONS!

Students & Teachers: please complete all sections as fully as possible. Use the "Save & Continue" button at the bottom of the form to save your progress and come back if necessary.

Once you click on the "Submit & Send to Parent" button, an email will be sent to the Student's Parent/Guardian instructing them to complete their section and submit the form.
- Name*
  
  First NameLast Name
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Email*
  Please use your personal/home email if you have one.
- Birth Date*
  
  MonthDayYear
- What school district do you LIVE in?*
- What school are you currently attending?*
- YesNo
- Who is your legal guardian? List their name and relationship to you.
- Parent / Guardian Email Address?*
  example@example.com
- YesNo
- 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 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*
  
  MonthDayYear
- Please list any work experience that you do OR have done at school, in the community, or other workplace. Paid or unpaid.
- Company / Organization #1
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Supervisor's Name
- List any duties that you performed.
- Company / Organization #2
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Supervisor's Name
- List any duties that you performed.
- YesNo
- Please explain...
- YesNo
- Please explain...
- Michigan Rehabilitation Services (MRS)Michigan Bureau of Services for Blind People (BSBP)Riverwood CenterVocational Rehabilitation CounselorOther
- YesNo
- 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
- Is there any additional information you would like us to know?
- FAMILY Reference*
  
  First NameLast Name
- Relationship to the Student*
- Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Email*
  example@example.com
- SCHOOL Reference*
  
  First NameLast Name
- Title*
- Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Email*
  example@example.com
- COMMUNITY / OTHER Reference*
  
  First NameLast Name
- Title*
- Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Email*
  example@example.com
- Student's Total Credits to Date
  If applicable.
- Student's Cumulative GPA
  If applicable.
- 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
- Upload Documents
  
  Cancelof
- Parent/Guardian:
  
  Click the "Next" button to go to the Parent/Guardian section.

2026/2027 Project SEARCH Program Application