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The PILR logo is a dark outline of a building with six Roman-style columns each with a stalk of wheat in a contrasting color. The letters PILR appear in contrasting color at the roofline.Graphical text that reads Prairie Independent Living Resource Center, Hutchinson Kansas

Dedicated to the full inclusion of people with disabilities.

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DMD LogoDisability Mentoring Day
Mentee Application

DMD Home   • DMD Fact Sheet   • DMD Teacher Tip Sheet   • DMD Mentee Tip Sheet

 

The application to be a DMD Mentee is located below. All fields are required.
Application deadline in September 16, 2011 for Law Enforcement and Medical,
and September 23, 2011 for all other careers.

Download the Permission to Participate in DMD Form

Personal Information









Education Information


Employment Experience
(or other volunteer activities, hobbies, etc.)

Career Interests
List in order of preference the careers you might be interested in after high school. Please list a different career in each box. Please be aware that if you list the same career in every box the steering committee may be unable to place you or have to place you in a field that has no interest for you. If you are unsure of the career you are interested in pursuing, please look at the career clusters below and check the boxes of the career area that interests you.


The steering committee will make every effort to place you with a mentor in your first career choice. However, if that isn’t possible we will use your second and third choices to find you a placement.

Career Clusters
Many students are unsure what career they want to pursue after high school. Sometimes it is important to look at a certain career instead of a specific job. below you will find a list of career areas and some explanation of the types of jobs you might have if you worked in those fields. Please check the boxes of any career area you might be interested in learning about during Disability mentoring day.













Other Information
Will you need any accommodations to participate in DMD such as alternative format?
(Braille, Large Print, Sign Language Interpreters, etc.)


Do you have any dietary restrictions that the DMD committee needs to be aware of such as needing a diabetic meal? If so please explain.



School or Professional Contact
(Teacher, Professor, Counselor, Service Provider)