Discover LifeWorks at WKU

Your Journey Starts Today

We’re delighted that you are applying to the LifeWorks at WKU program. Our primary goal is your successful transition to independent living and meaningful employment. Applicants must have the desire, capacity and motivation to move toward independence, and a willingness to actively participate in all aspects of the LifeWorks program. Space is limited for the incoming class; therefore, it’s vital that your application packet is fully complete to be considered for admission. Applicants will not be considered for interviews until all the following have been received:

LifeWorks at WKU Admissions Application and $100 non-refundable application fee
Psychological Evaluation (with IQ testing) completed within the last three (3) years
High School and/or College Transcripts, also copies of IEP’s, 504 plans, or special accommodation records
History & Physical Report, provide a copy of most recent physical exam report – must be completed within the past 12 months from date of the admissions application
Applicant Essay, provide a brief personal statement describing why you want to enroll at LifeWorks at WKU and briefly describe your short and long-term life goals.
Recommendation Letter(s), provide at least two letters of recommendation from professionals such as a counselor, therapist, previous teacher/instructor, case manager, etc.

You will receive an e-mail confirmation once your application and supporting documents have been received. Once your full application packet has been reviewed and the admissions review committee determines that LifeWorks is a potential match for you, an interview invitation will be extended. Please be aware that additional information, assessments, or references may be requested during the application process to ensure that the LifeWorks at WKU program is suitable to meet your specific needs.

Should you have questions about the LifeWorks program or the application process, please contact the admissions team at 270.745.4380 or [email protected].

Step 1 of 9

Parent/Guardian Information
Parent/Guardian #1 Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Email Address*
Cell Phone*
Work Phone*
Parent/Guardian #2 Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Email
Cell Phone
Work Phone

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Educational Background Information
High School, Program or College currently attending or most recently attended*
Contact Person at the Institution*
First Last
Contact Person's Title/Position*
Contact's Email Address*
Office Phone*
Institution's Address*
Street Address Address Line 2 City State ZIP Code
Date Began at Institution*
Date Completed at Institution*
Graduation / Completion Date*
Names of other High Schools, Programs or Colleges most recently attended
Contact Person at the Institution
First Last
Contact Person's Title/Position
Contact's Email Address
Office Phone
Institution's Address
Street Address Address Line 2 City State ZIP Code
Dates Attended at Institution
Graduation / Completion Date
Month
Day
Year

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Services / Programs Information
Do you currently or have you ever received services from the Office of Vocational Rehabilitation (OVR)?*
If yes, please provide contact information below.
OVR Counselor First / Last Name
First Last
Phone
Address
Street Address Address Line 2 City State ZIP Code
Email
Date that Services Initiated
MM slash DD slash YYYY
Do you currently receive, or have you previously received other support services including but not limited to Medicaid waiver services, state funded, grant funded or other funded community support services? If so, please list and briefly explain below:*
(attach additional pages if needed)
Do you currently have a Case Manager, Support Broker, or Service Coordinator*
- Yes
- No
- Pending
Case Manager, Support Broker, or Service Coordinator Name
First Last
Case Manager, Support Broker, or Service Coordinator Email
Office Phone
Name
Agency Name
Agency Address
Street Address Address Line 2 City State ZIP Code
Program or Funding Source for this Service
Do you currently have a Mental Health Counselor or Therapist?*
- Yes
- No
- Pending
Mental Health Counselor or Therapist Name
First Last
Mental Health Counselor or Therapist Email
Office Phone
Name
Agency Name
Agency Address
Street Address Address Line 2 City State ZIP Code
Program or Funding Source for this Service
Do you currently have a Behaviorist?*
- Yes
- No
- Pending
Behaviorist Name
First Last
Behaviorist Email
Office Phone
Name
Agency Name
Agency Address
Street Address Address Line 2 City State ZIP Code
Program or Funding Source for this Service

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Applicant Memorandum of Understanding & Agreement
Statement of Authenticity
By submitting this form, I agree that all of the information is accurate and that, if accepted, I understand and agree with the following admissions criteria:
- I agree to attend and participate in the LifeWorks At WKU program and the required curriculum.
- I agree to the timeframe of the program, the program hours and to honor all program rules and expectations.
- I agree to actively participate in training and/or instruction during the scheduled program times.
- I agree that I am motivated toward independence and desire to learn the skills necessary for me to live independently and more fully within the community.
- I agree that I possess the level of self-help skills necessary to function safely in transitional housing (LifeWorks At WKU apartment) without direct supervision during unstructured activity or program hours.
- I agree that I have the desire to learn the skills necessary to find, secure and maintain employment, and to participate in developing a career plan that allows me to leverage my strengths and interests in a job that’s right for me.
- I agree that I want to obtain competitive employment and to work at least part-time while in the LifeWorks At WKU program.
- I affirm that I do not have a chronic history of legal difficulties including arrests or probation.
- I affirm that I have no chronic history of violence, aggression or threatening behaviors.
- I affirm that I have no history of inflicting harm to myself or others.
- I agree to give written consent to include my parents or guardians in addressing issues concerning my progress in the LifeWorks At WKU program.
You are responsible for the accuracy and thoroughness of all information provided. Full candor is a prerequisite to admission. Concealment of information or failure to fully disclose may result in denial of admission, revocation of admission, and/or suspension or dismissal. I certify that all the information provided in this application is true and complete to the best of my knowledge.
Name of Person Completing Application*
First Last
Relationship, if not the applicant
Date*
MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email
This field is for validation purposes and should be left unchanged.

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Discover LifeWorks at WKU

Your Journey Starts Today

Step 1 of 9

Applicant Information

Parent/Guardian Information

Educational Background Information

Services / Programs Information

Clinical Information

Additional Information

Adaptive Skills Inventory

Safety Skills / Safety Awareness

Social / Interpersonal Skills

Money Management Skills

Personal Care Skills

Other Life-Skills

Household Skills

Interview with LifeWorks at WKU Staff

Applicant Memorandum of Understanding & Agreement

Statement of Authenticity

Discover LifeWorks

Independent Living Takes Practice
Start Today

Discover LifeWorks at WKU

Your Journey Starts Today

Step 1 of 9

Applicant Information

Parent/Guardian Information

Educational Background Information

Services / Programs Information

Clinical Information

Additional Information

Adaptive Skills Inventory

Safety Skills / Safety Awareness

Social / Interpersonal Skills

Money Management Skills

Personal Care Skills

Other Life-Skills

Household Skills

Interview with LifeWorks at WKU Staff

Applicant Memorandum of Understanding & Agreement

Statement of Authenticity

Discover LifeWorks

Independent Living Takes PracticeStart Today

Independent Living Takes Practice
Start Today