Summer Series- Self Advocacy & Work Readiness Series
Inquiry Form
Please complete the form below and our team will reach out to you with more information regarding our exciting new summer series.
Parent and/or Guardian
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
E-mail
*
example@example.com
Student/Child Interested in Attending
*
First Name
Last Name
Child's Age
*
Is the student currently enrolled in a secondary, postsecondary, or other recognized educational program?
*
Please Select
YES
NO
Does the student have an IEP, 504 Plan, or other documented disability?
*
Please Select
YES
NO
Child's School & 26/27 Grade Level
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School
2026-2027 Grade Level
School District
*
Funding Sources
Easterseals Southwest Florida is an approved Division of Vocational Rehabilitation (VR) vendor and accepts Step Up For Students Family Empowerment Scholarship funds. Private pay rate is $500.00 per week
Is the student currently connected with Vocational Rehabilitation?
*
Please Select
YES
NO
If yes, VR counselor's name
VR counselor's email address
If no, are would you like to discuss the Vocational Rehabilitation application process with our case management team?
*
Please Select
YES
NO
Does your child receive the Family Empowerment Scholarship for Students with Unique Abilities (FES-UA)?
*
Please Select
YES
NO
Which funding source do you anticipate using?
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Vocational Rehabilitation
StepUp for Students FES-UA
Private Pay
Dates Interested in Attending
Participants may attend both Work Readiness and Self-Advocacy,or choose only one week. June and July offer the same programming.
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Work Readiness: June 8 - 12
Self Advocacy: June 15 - 19
Work Readiness: July 6 - 10
Self Advocacy: July 13 - 17
What interests you most about this series?
Self-advocacy
Communication Skills
Resume Building
Interview Practice
Workplace Behavior
Independence Skills
Other
What goals does the student have for this summer?
Are there accommodations or supports that would help the student participate successfully?
Submit
Services are funded by Florida’s Division of Vocational Rehabilitation (VR). If you would like to participate, start by contacting your VR counselor
Type option 1
Type option 2
Type option 3
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SUBMIT
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