Ua-acts- university of Alabama Autism Spectrum Disorders College Transition and S

Download 95.63 Kb.
Size95.63 Kb.

UA-ACTS- University of Alabamadescription: asdlogo.jpg

Autism Spectrum Disorders

College Transition and Support

205-348-9133 (UA-ACTS Office)

205-348-3130 (ASD Clinic)

Hello from UA-ACTS!

We are so pleased that you are interested in our program! As you know, this program is designed to support the successful transition of students with Autism Spectrum Disorders into The University of Alabama and throughout their college years. We ask all applicants to complete the attached information as an initial description of the prospective student’s strengths and weaknesses in the areas of academics, adaptive skills, social skills, etc. Completion of this application is the first step in admission to UA-ACTS, but there are other steps to complete before full admission to the program. Specifically, each student in consideration for admission to UA-ACTS must also:

  1. Be admitted to The University of Alabama (you may do this while you are applying to UA-ACTS, but be aware formal admission into the program can only occur once the student has been admitted to UA).

  2. Provide a letter from someone who works with this student in an academic setting outlining the student’s strengths and weaknesses, as well as the ways this individual could benefit from the services provided by the program. (see attached letter).

  3. Once application materials have been submitted, schedule an in-person interview with the student and at least one parent/caregiver (to be completed by February 1).

  4. Provide documentation and records regarding diagnosis, educational history, treatment history, etc. (see UA-ACTS website for requirements to document a diagnosis of an ASD at UA).

Please note that applications for UA-ACTS are reviewed beginning February 1st in the year that the student wishes to seek admission. Deadlines for admission to The University of Alabama, applications for housing and financial aid, etc. are set by the University and are subject to change. Please contact the Admissions Office at 1-800-933-BAMA or visit for more information.

We encourage all students who are considering The University of Alabama and UA-ACTS to complete a guided campus tour, often on the same day that the in-person interview is conducted. You may schedule these tours online or by phone with the University Admissions office.
We are happy to answer any questions you have regarding our program at any time, and you may call (205-348-9133) or email ( us for additional information.
We look forward to hearing from you soon!

Sarah M. Ryan, Ph.D.

Program Director, UA-ACTS

Assistant Professor, Department of Psychology

To Whom It May Concern:

The student who provided this form to you is applying for admission to the University of Alabama-Autism Spectrum Disorders College Transition Support Program (UA-ACTS). This program is a campus based program that provides supports to students with a diagnosis of high functioning Autism or Aspergers’ Syndrome at the University of Alabama. In order to determine how well a student fits with the program, we need to get information from multiple individuals who have worked with the student. We request that the enclosed form be completed and returned to the program by someone who has worked with the student in an academic setting.

Please be aware that we are not looking for students who have no notable difficulty as these students would not require our services. We are most interested in whether or not we can meet the needs the student has in order to continue to build on the student’s strengths, while helping them grow in the areas they have difficulty. We appreciate your time and feedback!


Sarah M. Ryan, Ph.D.

Program Director, UA-ACTS

Assistant Professor, Department of Psychology


Student’s Name: Teacher’s Name:

How do you know this student?

How long have you worked with the student?


What academic strengths does this student have?

What areas does the student need the most assistance in?

What tasks do you believe this student will need help with in a college setting?

What extracurricular activities does this student participate in?

Please describe any difficulty this student may have interacting with peers in the classroom (e.g., group work, participating in discussions).

Overall, what services do you think this student will need at the college level to assist him/her in making the transition (social, academic, organization, coping skills)? Please be specific.

Please list any additional comments or concerns you may have regarding this student in the space below.

Please return this form to the following address:

The University of Alabama

ASD Clinic/UA-ACTS Program

Box 870161

Tuscaloosa, AL 35487-0161

Application for Admission to UA-ACTS


*Application Instructions*

In order to ensure that all of your information and your student’s information is protected, we ask that you not use your child’s name on any page after page 1. All identifying information about your student should be on this page. On the remaining pages, please refer to your student as he/she, my student, or my son/daughter/grandson/etc. This will allow our admissions committee to provide a “blind” review of all applications.

Information about the STUDENT




 Male  Female

Date of Birth:

Click here to enter a date.

Email Address:


Information about the Family/Caregivers

Parent/Caregiver(s) Name(s):


Home Mailing Address:


Phone Numbers:





















Email 1:


Email 2:


Siblings (please include names and ages):


Current School Name:


School Address:


Student Status:

 Incoming Freshman

Expected Date of Graduation:      

Current High School GPA:      

 Transfer Student

Previous College/University:


Student Year at UA:

 Freshman  Sophomore  Junior  Senior  Unknown

Reason for transfer:


College GPA:


Previous Major:


Anticipated UA Start Date:

 Fall of      

 Summer of       (If you are admitted to UA-ACTS you have the option of beginning over the Summer rather than waiting until Fall)

ACT/SAT Score:


Has student been accepted to UA?

 Yes  Application Pending  Have Not Applied

Has student applied for housing?

 Yes  No

Has student applied for disability services at UA?

 Yes  No

Educational History (please attach copies of relevant documents, including IEP, transcripts, etc):

Current Academic Accommodations:


Academic Strengths/Best Subjects:


Academic Weaknesses/Difficult Subjects:


Please briefly describe the student’s study skills and habits:


Please describe any supports you are providing as a parent to assist the student with schoolwork (e.g., checking homework, organizing projects, monitoring assignment due dates, organizing planner/calendar, etc.,):


Diagnostic History (please attach copies of relevant documents, including evaluation reports):

Primary Diagnosis:


 Asperger’s Syndrome



Age at time of ASD Diagnosis:


Name and title of professional who made that diagnosis:


Additional Diagnoses:

(e.g., ADHD, Anxiety, Depression, Math Disorder, Dysgraphia)


Date of most recent evaluation:


Tests/Measures Administered:


Intervention History:

Past and Present Interventions

Type of Professional

Targeted Issues


Individual Counseling




Group Therapy/Counseling




Speech Therapy




Occupational Therapy




Physical Therapy








Medical History:
Please list any significant medical concerns for the student, including allergies, past or current conditions, etc.:      
Please list any medications that the student currently takes on a regular basis:



Condition for which it is


Length of time on






















Does the student take medications independently?

 Yes  No

How does the student remember to take medications and organize his/her medicine?


Does the student refill prescriptions independently?

 Yes  No

Prescribing Physician:


Contact Number:




Type of Physician:


 General Physician


Will the above physician continue to prescribe medications once the student begins at UA?

 Yes  No  Undecided

Are you interested transferring these prescriptions to a psychiatrist at the UA Student Health Center?

 Yes  No  Undecided

Information Regarding Adaptive Skills:

Has this student ever worked a job outside of the home?

 Yes  No

If yes, please describe the type of job, the responsibilities involved, and the strengths and weaknesses the student exhibited at the job site:      

Does the student:

Have and use a cell phone?

 Yes  No

Check voicemail on his/her cell phone?

 Yes  No

Have and use a computer?

 Yes  No

Will he/she bring a computer to campus?

 Yes  No

Have and use an email account?

 Yes  No

How frequently does the student check email (without being prompted)?

 Yes  No

Use a planner, smartphone, or electronic calendar to keep track of his/her schedule?

 Yes  No

Have a driver’s license?

 Yes  No

Will he/she bring a car to campus?

 Yes  No

Use public transportation?

 Yes  No

Have a checking account?

 Yes  No

Use a debit card?

 Yes  No

Wash and dry their clothes?

 Yes  No

Cook (using a microwave or stove)?

 Yes  No

Shop for clothing, food, or toiletries independently?

 Yes  No

Additional Information/Elaboration regarding the questions above:      

Please briefly describe the areas related to self-care and independent living that this student will need the most assistance with:      

Please describe supports that are currently provided your student to assist the student with daily living skills (e.g., doing laundry, reminding to shower, administering medications, etc.,):      

Information Regarding Social Interactions:

What extracurricular activities is this student involved in?

What are the student’s strengths in the area of social interactions?

What social skills does the student struggle with?

Miscellaneous Information:
What are the student’s goals for college and for a career?

Please describe what this student does in his/her free time.

What services offered by the UA-ACTS program do you think will be most valuable for the student?

Please use the remaining space to provide any additional information regarding the student, this application, etc.


Please Return Completed Application and Supporting Documents to:

The University of Alabama

ASD Clinic/UA-ACTS Program

Box 870161

Tuscaloosa, AL 35487-0161
Or Email to:

Share with your friends:

The database is protected by copyright © 2019
send message

    Main page