Camp CapABILITY Summer Program Application

Interested in being a part of our inaugural Camp CapABILITY? This camp is for students:

Between 16 and 21 years of age.
Enrolled in a recognized education program.
One or more of the following:
- Eligible for & receiving special education or related services.
- Eligible for & receiving accommodations with a 504 plan or IEP.
- Physical or mental impairment that substantially limits one or more major life activity.*

Services will be available in the form of a summer camp, run by New Horizons, an agency with a 70-year history of serving individuals with disabilities.

*At present, students who are served by the Van Nuys/ Foothill District of the California Department of Rehabilitation are eligible. We hope to add additional districts in the coming years.

Week 1: June 24-28, 2024
Focus on Job Exploration Counseling

Week 2: July 8-12, 2024
Focus on Postsecondary Enrollment Counseling

Week 3: July 15-19, 2024
Focus on Workplace Readiness Training

Week 4: July 22-26, 2024
Focus on Self-Advocacy

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* 1. What is your full name?

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* 2. Parent/ Guardian Name

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* 3. I am interested in: (Check all that apply)

Job Exploration: June 24-28, 2024

Postsecondary Opportunities: July 8-12, 2024

Workplace Readiness: July 15-19, 2024

Self-Advocacy: July 22-26, 2024

All of the Above

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* 4. What is your birth date?

Birth date

Date

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* 5. What is your gender?

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* 6. Applicant Email Address

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* 7. Parent/ Guardian Email Address

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* 8. What is your telephone number?

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* 9. What is your current address?

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* 10. Please specify your race and ethnicity. Check all that apply.

Asian

Asian Indian

Filipino

Laotian/ Hmong

Cambodian

Japanese

Vietnamese

Chinese

Korean

Other Asian Group

Hispanic and/or Latino

Cuban

Puerto Rican

Mexican/ Mexican-American

Other Hispanic/ Latino

Native Hawaiian or Other Pacific Islander

Guamanian/ Chamorro

Samoan

Hawaiian

Other Pacific Islander

Native American/ American Indian

White

Black/African-American

Choose Not to Identify

Other (please specify)

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* 11. Disability Information. Please check all that apply.

Blind

Low Vision

Deaf

Hard of Hearing

Chemical or Environmental Sensitivity

Communication (verbal, speech, other)

Immune (such as Crohn's disease, rheumatoid arthritis, other)

Intellectual/ Developmental (e.g. acquired brain injury, Down Syndrome, Epilepsy, Cerebral Palsy, Autism, Asperger's Syndrome, other)

Learning (e.g. dyslexia, dyscalculia, attention deficit disorder, other)

Mental or Behavioral Health

Mobility (e.g. spinal cord injury, muscular dystrophy, other)

Other (please specify)

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* 12. Have you participated in a summer program before?

Yes

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* 13. Accommodation Needs: Please check any of the following reasonable accommodations which will allow you to fully participate in Camp CapABILITY programming. The information is used only in the planning of the program, and not in making the selection of Camp participants.

American Sign Language Interpreter

Real-Time Captioning (CART)

Audio Description

Materials in Alternate Formats

Personal Care Attendant

Power Wheelchair

Manual Wheelchair

Other Mobility Aid

Other (please specify)

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* 14. School Name

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* 15. Current Grade Level

Freshman

Sophomore

Junior

Senior

Other (please specify)

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* 16. Current Reading Level

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* 17. What are your current plans for after high school? Select all that apply.

Apprenticeship/ Training Program

Certificate Program

2-Year College Degree (Community College)

4-Year College Degree

Other (please specify)

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* 18. What career fields are you currently interested in? Select all that apply.

Agriculture

Art and Design

Animal Care

Business

Computers/ Technology

Education

Government

Healthcare

Legal/ Criminal Justice

Social Services

STEM (Science, Technology, Engineering, Math)

Skilled Trades (Construction, Automotive Repair, Electrical, etc...)

Transportation

Other (please specify)

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* 19. Please tell us about any employment or volunteer experience you have.

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* 20. Please submit one letter of recommendation from a teacher, counselor, administrator, or community member who can tell us about you. Relatives and family members are not able to submit a letter.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 21. Please submit a written essay or video that tells us:
1) A little about you- your likes, experiences, your story, etc...
2) Your hopes for the future and what you would like to accomplish.
Essays should be limited to 500 words at most. Videos should be no more than 5 minutes.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Camp CapABILITY Summer Program Application

Question Title

* 1. What is your full name?

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* 2. Parent/ Guardian Name

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* 3. I am interested in: (Check all that apply)

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* 4. What is your birth date?

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* 5. What is your gender?

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* 6. Applicant Email Address

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* 7. Parent/ Guardian Email Address

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* 8. What is your telephone number?

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* 9. What is your current address?

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* 10. Please specify your race and ethnicity. Check all that apply.

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* 11. Disability Information. Please check all that apply.

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* 12. Have you participated in a summer program before?

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* 13. Accommodation Needs: Please check any of the following reasonable accommodations which will allow you to fully participate in Camp CapABILITY programming. The information is used only in the planning of the program, and not in making the selection of Camp participants.

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* 14. School Name

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* 15. Current Grade Level

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* 16. Current Reading Level

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* 17. What are your current plans for after high school? Select all that apply.

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* 18. What career fields are you currently interested in? Select all that apply.

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* 19. Please tell us about any employment or volunteer experience you have.

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* 20. Please submit one letter of recommendation from a teacher, counselor, administrator, or community member who can tell us about you. Relatives and family members are not able to submit a letter.

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* 21. Please submit a written essay or video that tells us:1) A little about you- your likes, experiences, your story, etc...2) Your hopes for the future and what you would like to accomplish.Essays should be limited to 500 words at most. Videos should be no more than 5 minutes.

* 21. Please submit a written essay or video that tells us:
1) A little about you- your likes, experiences, your story, etc...
2) Your hopes for the future and what you would like to accomplish.
Essays should be limited to 500 words at most. Videos should be no more than 5 minutes.