FOLLOW-UP FORM

FOR APPLICANTS WITH A DISABILITY

You are receiving this form because you indicated in the preliminary application that you have a
disability. An applicant’s disability is not a factor during the selection process for the FLEX and YES
programs. Your responses help American Councils provide reasonable accommodations during the
application process.

The FLEX and YES Programs welcome and encourage all eligible students to apply to the program.
The programs are committed to offering an inclusive and accessible program to students with
disabilities. During recruitment, accommodated testing materials are available to applicants with
disabilities. Finalists who come on program to the United States have access to reasonable
accommodations from their placement organizations, host families, and host schools, to ensure
they are as prepared to have a successful program experience.
If you need more space to write your answers, you may use additional paper.
I. General Information
Student name (last, first, middle):
Student ID number (last 6 digits):
Country: Kyrgyzstan
Date of birth (month/day/year):
Name of disability:

Date of onset of disability: o At birth (congenital)

o Other; if other, indicate cause and date:

Name of school:

Is this a specialized school for o Yes o No

students with disabilities?

Does your disability affect Provide a brief description:

your (check all that apply):
o Vision Describe:
o Hearing
o Movement
o Learning style
o Other

Please briefly describe the accommodations you generally use in school or everyday life.
 FOLLOW-UP FORM
FOR APPLICANTS WITH A DISABILITY