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Neurodiversity Support Center (NSC) Application
Please complete the application below.
If you have any questions, reach out to Nancy Gray at ngray@nmc.edu or 231-995-2091. When the NSC application is completed and submitted, you will be contacted to schedule an interview with an NSC staff member.
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* Indicates required question
Email
*
Your email
First and last name:
Your answer
Preferred Name:
Your answer
Date of Birth:
Your answer
NMC Student ID
Your answer
Pronouns:
Your answer
Gender Identity (male, female, non-binary, etc.):
Your answer
Student's Address (street address, city, state, zip code):
Your answer
Student's phone number:
Your answer
Student's NMC Email:
Your answer
Student's preferred email:
Your answer
Parent/Guardian #1
Name:
Your answer
Parent/Guardian #1
Address:
Your answer
Parent/Guardian #1
Phone number:
Your answer
Parent/Guardian #1
Email:
Your answer
Parent/Guardian #2
Name:
Your answer
Parent/Guardian #2
Address:
Your answer
Parent/Guardian #2
Phone number:
Your answer
Parent/Guardian #2
Email:
Your answer
How did you find out about the Neurodiversity Support Center?
NMC Website
High school counselor
NMC Event
NMC counselor
NMC Adviser
NMC Faculty
NMC Disability Support Services
Social media
Personnel at another college or university
Other:
Current Educational Status
High school student
Transfer student
Currently-enrolled NMC student
If you checked "high school student," please share the following:
High school name, location (city and state)
Current grade level
Current Grade Point Average (GPA)
Did you receive any dual-enrollment credits?
If so, how many?
Anticipated major
Your answer
If you checked "transfer student," please share the following:
Transferring from (school name, city, state)
Reason for transferring
Number of credits completed
GPA
Anticipated major
Your answer
If you checked "currently enrolled NMC student," please share the following:
Declared major
Number of semesters completed at NMC
Your answer
Did you have an IEP or 504 plan in high school?
Yes
No
Clear selection
Did you receive accommodations through a 504 plan or IEP in high school?
Yes
No
Clear selection
If yes, please list your accommodations:
Your answer
If yes, under what category did you receive an IEP or with what diagnosis did you receive a 504 plan?
Your answer
Please list any additional diagnoses that have been formally assessed:
Your answer
Please indicate below any support services you currently receive or have received within the past three years:
Tutoring
Special Services for ASD/Learning Disabilities
ABA
Group Therapy
Speech and Language Therapy
Occupational Therapy
Resource Room Program
Other:
Please indicate if you receive any of the following outside supports:
Open case with Michigan Rehabilitation Service
Open case with Bureau of Services for Blind Persons
Other:
Do you plan to register with NMC Disability Support Services?
Yes
No
Maybe
Clear selection
Personal Statements (to be completed by the student)
What are your expectations of NSC? What do you think you will need help with?
Your answer
Based on previous experiences, what are your academic strengths?
Your answer
Based on your previous experiences, what are your academic challenges?
Your answer
How do you learn best?
Your answer
How do you enjoy spending free time?
Your answer
Do you have any particular academic or career interests? If so, what are they?
Your answer
Are you involved with any teams, clubs, or organizations? If so, which ones?
Your answer
What are some barriers you have encountered through your educational and social experiences?
Your answer
Please provide additional information that you feel would be important for us to know about you.
Your answer
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