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Compass Program Application

* indicates required field

Round: Non-Degree (HIDDEN)

Round Always Create (HIDDEN)

Generate Pin (HIDDEN)

Submitted Flag (HIDDEN)

Submitted Date (HIDDEN)

Student Type: Non-Degree (HIDDEN)

Program: Compass Program (HIDDEN)

Contact Information

Legal First Name*

Middle Name

Last Name*

Preferred First Name

Email Address*

Birthdate*

Gender*

Mailing Address*

Country

Street

City

Region

Postal Code

Phone Number*

Personal Information

Country of Citizenship*

Are you a Permanent Resident of the United States?

Yes

Social Security Number

Many groups, including the government and accrediting agencies, ask universities to describe the ethnic/racial backgrounds of their students and employees. In order to respond to these requests, we ask you to answer the following two questions.

Are you Hispanic or Latino?

Yes

Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member:

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Education

High School Name*

High School Diploma Date*

High School Counselor's Name

High School Counselor's Email

Level of Study = HS (HIDDEN)

CEEB (HIDDEN)

Have you attended any post-secondary educational institutions?

Yes

College Name*

Level of Study = UG (HIDDEN)

CEEB (HIDDEN)

Enrollment Information

When do you plan to enroll?*

What extracurricular activities are/were you involved with?

Required Documents

Please provide most recent academic year Individualized Education Program (IEP)*

Partial or summary IEPs will not be accepted.
Please include the transition plan if developed by school district.

Please provide Psychological or Psycho-Educational Reports*

All reports must be performed by a medical doctor, registered psychologist, or psychiatrist within the last three years that confirm student has an intellectual or developmental disability.

Please provide official high school transcript, transition program or college transcripts (if existing)*

Please provide a resume or summary of work history*

Letters of Recommendation (3 Required):

Recommendation letters should discuss the applicant’s long-term interest in attending college and seeking employment after graduation.
Letters may not be written by relatives of the Compass applicant and should be written by people who have known the applicant for a minimum of three years.
Examples of appropriate writers include guidance counselors, transition coordinators, teachers, work supervisors, coaches/student organization advisors, or anyone who can speak to the student regarding educational background, vocational/employment experiences, community involvement, and the individual as a whole.

Please attach Letter of Recommendation 1*

Please attach Letter of Recommendation 2*

Please attach Letter of Recommendation 3*

Getting to Know You

Getting to Know You
Please answer the following questions by providing bullet points or a brief paragraph:

Why you would like to go to college?*

What would you like to study in college? If you are interested in more than one thing, please let us know.*

Please send to us via email a 1-2 minute video telling us about yourself. This video should be in your own voice - in your own format. Tell us your interests, what you like to do during the day, your favorite classes or clubs. Be creative and have fun!

Your video can be sent to Dr. Alia M. Pustorino-Clevenger at pustorinoa@duq.edu.

Family Information

Father/Guardian/Spouse

Relationship

Father

Legal Guardian

First Name

Last Name

Street Address

City

State

Postal Code

Phone Number

Email Address

Mother/Guardian/Spouse

Relationship

Mother

Legal Guardian

First Name

Last Name

Street Address

City

State

Postal Code

Phone Number

Email Address

Additional Information

Are you a Duquesne employee or the child of a full-time Duquesne employee?

Yes

Please list employee's name and department

Are you a related to an alumnus of Duquesne University?

Yes

Select relative. If more than one, select 'Multiple.'

Are you a veteran?

(Under Federal Law a Veteran is any person, who served honorably on active duty in the armed forces of the United States. Discharges marked General and Under Honorable Conditions also qualify).

Are you a veteran?

(Under Federal Law a Veteran is any person, who served honorably on active duty in the armed forces of the United States. Discharges marked General and Under Honorable Conditions also qualify).

Yes

Are you the dependent (son or daughter) of a veteran?

Yes

Are you a spouse of a veteran?

Yes

Service Provider/Tuition Assistance Information

Are you receiving Medicaid Waiver Services?*

Yes

Are you receiving Case Management Services?*

Yes

Case Manager Name*

Case Manager Phone Number*

Are you currently receiving support from Vocational Rehabilitation Services?*

Yes

For which of the following, if any, Tuition Assistance Programs are you eligible?

SAGE

TAP

Tuition Exchange and/or CIC

What is the amount of your tuition award?*

Are you Pittsburgh Promise eligible?*

Yes

Duquesne University Admissions Required Information

Criminal Charges

Are there any criminal charges presently pending against you other than a summary traffic offense? (Answering 'yes' to this question will not eliminate you from consideration for admission to the University.)*

Criminal Charges

Yes

Describe in full detail: Please give the approximate date of each incident, explain the circumstances, and reflect on what you learned from the experience.*

Conviction Charges

Have you ever been convicted, pled guilty or no contest to a crime other than a summary traffic offense? (Answering 'yes' to this question will not eliminate you from consideration for admission to the University).*

Conviction Charges

Yes

Describe in full detail: Please give the approximate date of each incident, explain the circumstances, and reflect on what you learned from the experience.*

I authorize the Compass Program to use my image (in still or motion photography) in its promotional materials.

Yes

I certify that the information on this application is complete and correct, and I understand that the submission of false information is grounds for denial of my application, withdrawal of any offer of acceptance, cancellation of enrollment or any appropriate disciplinary action. I authorize the University to verify the information I have provided with all the schools I have attended. I agree to notify the proper officials of the institution of any changes in the information provided.*

Signature of Parent or Guardian