iCan Work Application
Applicant Information
First Name: *
Your answer
Last Name: *
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Date of Birth *
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Address 1: *
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Address 2:
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City: *
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State: *
Zip *
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County *
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Phone Number: *
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Email: *
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Parent's First Name: *
Your answer
Parent's Last Name: *
Your answer
Program Information
Have you applied for APD services in the state of Florida? (or any other state) *
Is the applicant currently on the APD wait-list in the state of Florida? *
Does the applicant currently receive APD funding? *
If yes, for what services?
Your answer
If no, has the applicant ever received funding from APD?
Your answer
Name of High School attended. *
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What year did the applicant graduate? *
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Is the applicant currently employed? *
If no, has the applicant ever been employed?
Does the applicant do any volunteer work in the community? *
If yes, please explain what kind of volunteer work.
Your answer
Has the applicant ever received services from Vocational Rehab? *
Does the applicant receive any other funding from private/government sources? *
If yes, please explain.
Your answer
Will the applicant require transportation assistance to/from work? *
Is the applicant able to read? *
What are the applicants primary interests (hobbies and/or job interests)? *
Your answer
Comments:
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This form was created inside of Down Syndrome Foundation Of Florida.