TransAccess - The Source for Accessibility Solutions

"TransAccess provides persons with disabilities access to adaptive technology and career transition services
so that they can achieve their desired education and employment, and improve their quality of life."

School-to-Future Online Application

To be considered for TransAccess' School-To-Future Program, you must meet all of the following:

Be at least 15 years of age at time of application.
Have a disability and be capable of pursuing competitive employment.
Currently reside or plan to reside in Santa Clara County or the San Francisco South Bay Area.
Be currently enrolled in high school, a community college, a college/university trade school or a private commercial training center. (May be considered if graduated within the past 12 months or in the process of continuing education within the next 3 months after completion of application. Classes must be relevant to career objectives).
May be required to complete a Release of Information Form to verify disability and/or request other medical or educational records.

If you meet these qualifications fill out the online form below to continue or click here for a printable version (requires Adobe Reader to view).

Personal Information:

Name *:

Address:

City:

State:

Zip code:

Phone:

E-mail *:

Date of birth:

Age:

Gender:

Male Female

Emergency Information:

Person to be contacted in case of emergency:

Phone number:

Specific medical conditions, e.g., Diabetes, Epilepsy,

Allergic Reactions, etc:

Other information:

Education Information:

School/College

Date graduated:

Do you presently have a college degree:

Yes No

Date graduated:

If yes, from what college/university?

Disability Information:

Do you have a disability?

Yes No

If yes, please check the most appropriate box:

Blind or Visual Impairment
Deaf
Mobility

Head Injury
Learning Disability
Other

Describe primary disability:

Do you have a secondary disability?

Yes No

If yes, describe:

Do you use a wheelchair or have specific mobility limitations?

Yes No

If yes, describe:

Do you require adaptive devices?

Yes No

If yes, describe:

Additional Information:

How did you learn about the School-To-Career Program?

School/College
Counselor
Community Agency

Friend
Website
Other

Check if you are currently a client with:

State Department of Rehabilitation
Private Vocational Rehabilitation

Counselor's name:

Phone number:

Home phone:

Work phone:

Method of transportation:

Drive
Use Public Transportation
Use Paratransit

Race and National Origin:

The categories below are designed to most closely identify a student's racial and national origin. The purpose of this identification is to help TransAccess obtain statistical records and required information used for certain Federal, State and other funding sources.

Native Indian or Native Alaskan
Asian or Pacific Islander
Black, African-American (Not of Hispanic Origin)
Hispanic
White (Not of Hispanic Origin)
Do not wish to designate

( * denotes required fields)