Application to Participate



NKU Supported Higher Education Project: SHEP Application

* To be considered for the SHEP program, you must submit two letters of recommendation.

Today’s Date: ______________

Student Participant Contact Information:

Name: _________________________________________________________________

Address: _______________________________________________________________ _________________________________________________________________

Student’s Cell Phone Number: ______________________________________________

Student’s Email Address: __________________________________________________

Student’s Date of Birth: ____________________________________________________

Parent/Guardian Contact Information:

Parent/Guardian Name: ____________________________________________________

Parent/Guardian Phone Number: _____________________________________________

Parent/Guardian Email Address: _____________________________________________

Tell Us About Yourself:

1. If you are currently a high school student, please write the name of your high school:

__________________________________________________________________

When will you finish high school? ___________ (month, year)

What year do you plan to begin college? ___________ (month, year)

2. Did you exit high school (or do you plan to do so) with:

_____Diploma

_____ Alternate Diploma

_____Certificate of Attainment

3. If you are currently NOT a high school student, what do you do during the day?

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

4. Do you receive services from any of the following:

____OVR (Voc Rehab) ____ SCL

____Michelle P. Waiver ____Consumer Directed Option (CDO)

____Hart-Supported Living ____Home/Community Based (HCB)

____Other_____________________________________________________

6) The purpose of SHEP is to help students continue their education beyond high school. Please tell us why you would like to continue your education beyond high school and go to college:

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

7) What do you see yourself studying? What kinds of classes do you think you would expect to take?

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

8) Who will be supporting you as you pursue a college education? (Mark all that apply.)

____Parents/Guardians ____Siblings

____Neighbor ____Other Relatives

____ Friends

____Other (Explain) _____________________________________________

9) Where do you expect to live while you go to college?

___At home, with parents

___In a college dormitory

___Other (please explain) ___________________________________________

10) If you were to attend college, how would you get there?

____Drive my self

____Parents and family members

____ Friends

____Carpool

____City Bus

____Uber or Taxi

____Don’t know

____Other (Please explain)__________________________________________

11) What do you think will be the easiest part of going to college? ________________________________________________________________________________________________________________________________________________________________________________________________________________________

12) What do you think will be the hardest part of going to college?

________________________________________________________________________________________________________________________________________________________________________________________________________________________

13) What kinds of supports do you think you need to go to college? What seems to help you best? ______________________________________________________________________

______________________________________________________________________

14) How did you hear about the SHEP program? ____________________________________________________________________________________________________________________________________________________________________________________

We look forward to talking with you.

Please return this application, along with two letters of reference to:

Emily Hellmann, SHEP Program Coordinator

Northern Kentucky University

College of Education

MEP 100, Nunn Drive

Highland Heights, Kentucky 41099

You can reach Emily at hellmane2@nku.edu or 859-572-6149

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