Clone of HALO 2-Year Application Form

HALO Program at Heartland Community College

1500 Raab Rd, Normal, IL, 61761

halo@heartland.edu

www.heartland.edu/halo

(309) 268-8255
HALO Application Form

Please fill out the application form carefully. All application materials must be received by July 6, 2026.
Program Information
Select the program you are applying for:*

2-Year Certificate ProgramTransition YearUncertain
Please explain your questions regarding program selection.*
Select the campus you wish to attend:

NormalPontiac
Applicant Information
Full Legal Name*

First NameLast Name
Preferred Name
Preferred Pronouns
Birth Date*

MonthDayYear
Applicant's Phone Number
If applicant does not have their own personal phone number, please leave this blank.
Applicant's Personal E-mail
Do not use a school email. If applicant does not have their own personal email address, please leave blank.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent Information*
Applicant's Guardianship Status*

Own legal guardianCourt appointed legal guardianAssigned power of attorney
Note: Guardianship documentation will need to be submitted if the applicant is admitted to the program.

Behavioral Information
Does the applicant displayed any aggressive behaviors, either physically or verbally?*

RegularlyOccasionallySeldomNever
Please explain. Include the nature of the situation(s), the applicant's response and the result.*
Does the applicant have a history of legal issues, arrests, or probations?*

YesNo
List the date(s) and nature of the situation(s).*

Additional Required Documentation

You may upload the additional required documentation to this form, or you may email them separately to halo@heartland.edu. Please note that all materials must be received on or before the July 6, 2026, deadline.
High School IEP or 504, Junior Year

Cancelof
Official School Transcript

Cancelof

Statement of Authenticity
Who completed this application?*

ApplicantAnother adultBoth applicant and another adult
Relationship to Applicant*
By signing below, I certify that all of the information in this application is true anc complete to the best of my knowledge. I understand that this application does not guarantee acceptance to the HALO Program.
Applicant's Signature*

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Preparer's Signature*

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Scholarship Form

Heartland Community College Foundation has limited scholarships exclusively available to students in the HALO Program. Please consider your family's need when responding to the questions below.
Does the applicant anticipate receiving any other scholarships, funding or financial aid assistance?*

YesPossiblyNo
Please list award(s) and the amount associated with each.*
Identify your need status as accurately as possible:*

51-100% CoverageAnything would helpUp to 50% CoverageNo Financial Assistance Needed
Comments
NOTE: The following questions MUST be completed by the student. If there are any concerns regarding this, the student may be asked to resubmit their responses.
Please describe how the coverage amount would support you financially throughout the HALO program.*
Share three reasons why it is important to you to become a HALO student at Heartland Community College.*
Select one of these questions to answer.*

What is one of your best characteristics and why is that characteristic important for your success in the HALO Program?Identify a time when you had an obstacle in your path to success and describe how you overcame that obstacle.
What is one of your best characteristics and why is that characteristic important for your success in the HALO Program?*
Identify a time when you had an obstacle in your path to success and describe how you overcame that obstacle.*
All information will be considered when reviewing scholarship applications submitted prior to the deadline. Any applications submitted after the deadline may not be eligible for consideration.

By signing, the applicant understands that no scholarship funds are guaranteed. The applicant also acknowledges that they have submitted their own original work, and that they are truthful in their responses.
Applicant's Signature*

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Should be Empty:

Rows	Consistently	Learning	Not at all	Unsure
Advocate needs
Communicate emotions
Demonstrate safe behaviors
Display honesty
Initiate conversations with others

Rows	Consistently	Learning	Not at all	Unsure
Navigate conflict well
Manage frustrations with others
Handle correction or redirection from a leader
Manage distractions

Rows	Consistently	Learning	Not at all	Unsure
Independently log on to a computer
Remember or use strategies to recall passwords
Create and save a document on their own
Practice cyber safety

Rows	Independently	With Occasional Reminders	Needs Regular Prompts	Not At All
Take care of basic hygiene (i.e. shower, wash and comb hair, apply deodorant, wear clean clothes, etc.)
Navigate the environment with practice
Follow safety procedures when crossing streets and walkways
Arrive at a set location at a set time

HALO Application Form

Program Information

Applicant Information

Educational and Support Services Information

Behavioral Information

Skill Levels

Additional Required Documentation

Statement of Authenticity

Scholarship Form