Future Students Request for ASN Program Appointment

Please fill out this form if you would like to be part of the ASN program. Indicate if you need more information in order to complete any of the steps, and we’ll get back to you with the information.

Note: We must receive this form by July 15, so be sure to start early!  Email us at asn@bellevuecollege.edu if you are having difficulty with the deadline – we’re here to help!

Fall 2019 Future ASN Student Request for Appointment

Fill out this form as your first step towards becoming a student in the Autism Spectrum Navigators program at Bellevue College.
  • Your pronouns
  • Date Format: MM slash DD slash YYYY
  • Have you attended an Autism Spectrum Navigators Information Meeting? * Required
    (Please note: You must attend an Information Meeting prior to meeting with our staff for this appointment request.) Please indicate whether or not you have attended one of these information meetings. ASN Information Meetings are held on the 2nd Monday evening of each month (January through June) at 7 p.m. in D106. If you've missed this date, you can view a webinar version. The details are here: www.bellevuecollege.edu/autismspectrumnavigators/about/information-sessions/
  • Please choose at least three of the times below that you are available for a 45-60 minute appointment to come and talk to us at Bellevue College about your interest in the ASN program. We want to make sure it's a good fit for you! Appointments must be completed by August 2, 2019. You may bring someone with you if you'd like to.
  • Please tell us the best way to reach you to set up an appointment. Please note that if you would like us to include someone other than yourself in the contact, you must fill out a Release of information form for them. https://s.bellevuecollege.edu/wp/sites/36/2014/01/FERPA.pdf
  • Your Bellevue College Email * Required
    You must have a BC email prior to filling out this form. If you need help setting up this email, check this link first to create your account: www.bellevuecollege.edu/netid/default.aspx, then contact us if you still need help.
  • Your Personal Email * Required
    We will only use this email address as a backup email address, and only to contact you about college and ASN program information.
  • Emergency Contact Email * Required
    We will only use this email in an emergency situation, or if we have a signed release of information form (FERPA form) from you. If you would like us to include this person in email correspondence, please fill out the form found at the following link, and email it to us: https://s.bellevuecollege.edu/wp/sites/36/2014/01/FERPA.pdf . NOTE: We cannot include anyone on emails or phone calls without the signed FERPA form.
  • Knowing what city you live in helps us with our meeting scheduling.
  • Have you taken the English Assessment? * Required
    You must go to the Testing Center (Step 5 on the checklist) prior to our meeting and be assessed into an English class level. Please let us know if you have questions!
  • Please tell us what English Class you assessed into OR give us more information about the assessment here. If you have not yet taken the assessment, you must take it and send us the information PRIOR to your appointment.
  • Have you filled out an Initial Access Request form for the Disability Resource Center? * Required
    Please indicate whether or not you have filled out an Initial Access Request Form for the Disability Resource Center. Filling out an Initial Access Request Form is your first step towards receiving ADA Accommodations in college. Go in person to B132 or fill out a Web Form here: www.bellevuecollege.edu/drc/forms/initialaccess/ (NOTE: this is not required for participation in the ASN program, however, it is recommended.)
  • Have you sent documentation of disability to the Disability Resource Center?
    Your next step towards receiving ADA Accommodations in college is to send (or deliver) documentation of disability to the DRC. Please indicate whether or not you have done this. (NOTE: this is not required for participation in the ASN program, however, it is recommended.)
  • Please feel free to let us know anything that you think is important for us to know about your involvement in the Autism Spectrum Navigators program.
  • This field is for validation purposes and should be left unchanged.

Last Updated April 6, 2019