Parent/Guardian Recommendation and Consent Neurodiverse Learners (NNL) Program

This form is part of the application packet for the Neuroscience for Neurodiverse Learners (NNL) Program. To learn about the other components of the program, visit the Summer Program page.

You can also access the full application in Spanish, Russian, or Vietnamese.

Instructions: A parent or guardian must complete the form below and the short essay questions.

All NNL program offerings are contingent upon receipt of continued funding. All participants are required to be citizens or permanent residents of the United States or its possessions. The University of Washington reaffirms its policy of equal opportunity regardless of race, color, creed, religion, national origin, sex, sexual orientation, age, marital status, disability, or status as a disabled veteran, or Vietnam era veteran in accordance with University policy and applicable federal and state statutes and regulations.

Student's Name

Student First Name

Student Last Name

Primary Parent/Legal Guardian Contact Information

Parent/Legal Guardian First Name

Parent/Legal Guardian Last Name

Parent/Legal Guardian Address

Parent/Legal Guardian Phone

Parent/Legal Guardian Email

2nd Parent/Legal Guardian Contact Information

Parent/Legal Guardian 2 First Name

Parent/Legal Guardian 2 Last Name

Parent/Legal Guardian 2 Address

Parent/Legal Guardian 2 Phone

Parent/Legal Guardian 2 Email

3rd Parent/Legal Guardian Contact Information

Parent/Legal Guardian 3 First Name

Parent/Legal Guardian 3 Last Name

Parent/Legal Guardian 3 Address

Parent/Legal Guardian 3 Phone

Parent/Legal Guardian 3 Email

4th Parent/Legal Guardian Contact Information

Parent/Legal Guardian 4 First Name

Parent/Legal Guardian 4 Last Name

Parent/Legal Guardian 4 Address

Parent/Legal Guardian 4 Phone

Parent/Legal Guardian 4 Email

Questions

1. Explain why you consider the applicant a good candidate for the NNL Summer Program

2. What are your student applicant’s greatest strengths?

3. What types of accommodations and supports are helpful to your student applicant?

4. Is there additional information regarding the applicant that would be useful to DO-IT Staff?

How did you hear about this program?

Applicant Approval

Please give approval for (applicant) to participate in the Neuroscience for Neurodiverse Learners (NNL) Student Program. *

I do