Online Admissions Application Step 1 of 22 4% Which location are you applying to?(Required) EGTI Muncie EGTI Indianapolis Financial InformationBefore submitting an application to EGTI, applicants are encouraged to review information regarding tuition and fees on EGTI's website and have an established plan to financially support their programming. If the applicant currently has an open case with Vocational Rehabilitation (VR), a meeting should be had prior to submitting an application to ensure the counselor agrees that the chosen training program aligns with the applicant's Individualized Plan for Employment (IPE). If an applicant is currently going through the intake process with VR, it is recommended that the applicant wait to apply until a VR counselor has been assigned and an IPE has been written. *Please note that it is not a requirement that applicants work with VR.Please select the applicant's plan for financial support:(Required)Select All that Apply Scholarships Self-Pay Vocational Rehabilitation Training ProgramsWhich Traininig Session are you applying for?(Required) 2024 Training Session 1 - January 8 - March 28, 2024 2024 Training Session 2 - April 15 - June 21, 2024 2024 Training Session 3 - July 15 - October 4, 2024 2024 Training Session 4 - October 14 - December 20, 2024 2024 Training Session 1 - January 8-March 28, 2024 (12 Weeks)(Required) Heart of the House: All Positions (Hotel) Heart of the House: Laundry Attendant Only (Hotel) Kitchen Cook (Healthcare) Patient Transport (Healthcare) 2024 Training Session 2 - April 15-June 21, 2024 (10 Weeks)(Required) Host/Server Assistant (Restaurant) Dishwasher/Server Assistant (Restaurant) Nutrition Services (Healthcare) Inventory Distribution (Healthcare) 2024 Training Session 3 - July 15-October 4, 2024 (12 Weeks)(Required) Heart of the House: All Positions (Hotel) Heart of the House: Laundry Attendant Only (Hotel) Front Desk Agent (Hotel) Kitchen Cook (Healthcare) Hidden2024 Training Session 3 - July 15-October 4, 2024 (12 Weeks) Heart of the House: All Positions (Hotel) Heart of the House: Laundry Attendant Only (Hotel) Front Desk Agent (Hotel) Kitchen Cook (Healthcare) 2024 Training Session 4 - October 14-December 20, 2024 (10 Weeks)(Required) Host/Server Assistant (Restaurant) Dishwasher/Server Assistant (Restaurant) Environmental Services (Healthcare) Inventory Distribution (Healthcare) Hidden2024 Training Session 4 - October 14-December 20, 2024 (10 Weeks) Host/Server Assistant (Restaurant) Dishwasher/Server Assistant (Restaurant) Environmental Services (Healthcare) Inventory Distribution (Healthcare) Which Traininig Session are you applying for?(Required) 2024 Training Session - August 1st - October 4, 2024 (Students will end the program as employees of Allison Transmission) Applicant InformationName:(Required) First Last Primary Phone:(Required)Gender:(Required) Male Female Address:(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code County:(Required) Birth Date:(Required) Email:(Required) How did applicant hear about EGTI?(Required) Teacher Vocational Rehabilitation Counselor Job Coach Disability Awareness/Transition Fair Medicaid Waiver Staff Other Please share what other source informed you about EGTI? Did applicant attend an onsite presentation or tour at EGTI Muncie?(Required) Yes No Has applicant attended a Career Sampling Session at EGTI Muncie?(Required) Yes No Education & TrainingList(Required)Click the "+" sign to add additional rowsSchool's NameCity & StateYears AttendedReasons for Leaving (Diploma, Certificate of Completion, GED, or Dropped Out)Completion Year Add Remove Employment HistoryDoes the applicant have any employment history?(Required) Yes No Name of Business:(Required) Average Length of Shifts:(Required) Dates of Employment:(Required) Reason for Leaving:(Required) Job Responsibilities:(Required)Support Services Provided:(Required)Was the applicant paid:(Required) At minimum wage Above minimum wage At sub-minimum wage Does applicant have another place of employment?(Required) Yes No Name of Business:(Required) Average Length of Shifts:(Required) Dates of Employment:(Required) Reason for Leaving:(Required) Job Responsibilities:(Required)Support Services Provided:(Required)Was the applicant paid:(Required) At minimum wage Above minimum wage At sub-minimum wage Does applicant have another place of employment?(Required) Yes No Name of Business:(Required) Average Length of Shifts:(Required) Dates of Employment:(Required) Reason for Leaving:(Required) Job Responsibilities:(Required)Support Services Provided:(Required)Was the applicant paid:(Required) At minimum wage Above minimum wage At sub-minimum wage Does applicant have another place of employment?(Required) Yes No Name of Business:(Required) Average Length of Shifts:(Required) Dates of Employment:(Required) Reason for Leaving:(Required) Job Responsibilities:(Required)Support Services Provided:(Required)Was the applicant paid:(Required) At minimum wage Above minimum wage At sub-minimum wage Volunteer ExperienceDoes the applicant have any volunteer experience?(Required) Yes No Name of Business:(Required) Average Length of Shifts:(Required) Dates of Volunteering:(Required) Reason for Leaving:(Required) Volunteer Responsibilities:(Required)Support Services Provided:(Required)Does applicant have another volunteer experience to add?(Required) Yes No Name of Business:(Required) Average Length of Shifts:(Required) Dates of Volunteering:(Required) Reason for Leaving:(Required) Volunteer Responsibilities:(Required)Support Services Provided:(Required) Support ServicesApplicant currently receives support from:Check all that apply Health & Wellness Waiver Community Integration & Habilitation Waiver (CIH) Family Support Waiver (FSW) Traumatic Brain Injury Waiver (TBI) Medicaid Medicare Social Security Disability Insurance Supplemental Security Income Vocational Rehabilitation Services Mental Health/Psychological Services Other Please explain what other support services that applicant receives:(Required) Please list adaptive equipment or assistive technology the applicant utilizes on a daily basis (e.g. wheelchair, gait trainer, augmentative communication device,etc.)Please list any services currently being received:Click the "+" icon to add additional rows.Service (waiver support, counseling, VR, etc.)Hours per Week/Day Add RemoveRoom ArrangementsWhat room arrangements does the applicant prefer?(Required) A Roommate Single Room Commuter Applicant InformationDoes the applicant have a legal guardian?(Required)Note: If you select "yes", this means you have gone to court, and a court has declared that the applicant is a protected person. Documentation is required. Yes No Guardian's Name:(Required) First Middle Last Address:(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone:(Required)Email:(Required) Does the applicant have another guardian?(Required) Yes No Guardian's Name:(Required) First Middle Last Address:(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone:(Required)Email:(Required) Parent InformationParent's Name:(Required) First Middle Last Address:(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone:(Required)Email:(Required) Parent's Name: First Middle Last Address: Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone:Email: Emergency ContactsMUST List TwoContact #1 Name:(Required) First Last Phone(Required)Relationship to Applicant:(Required) Contact #2 Name:(Required) First Last Phone(Required)Relationship to Applicant:(Required) Allergy InformationPlease note any allergies that staff should be aware of.(Required) Level of Support QuestionnaireTHIS SECTION MUST BE COMPLETED BY A PARENT OR GUARDIANName of person completing the questionnaire:(Required) Relationship to applicant:(Required) Independent Living Please rate the applicant in the areas below.Can Manage Time:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Can Perform Entire Hygiene Routine:(Required)(e.g. shower, dress, brush teeth, etc.) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Maintains Proper Hygiene:(Required)(e.g. clean nails, hair, face, etc.) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Can Do Laundry:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Can Order From a Menu:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Can Stay Within a Budget:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Can Be Alone for a Long Period of Time Without Supervision:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Displays a Self-Regulation Strategies:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Knowledgeable About Basic Over-the-Counter Medications:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Can Manage Medication:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Can Manage Dietary Needs:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Understands Allergies & Takes Precautions:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Can Manage Personal Belongings:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Social Communication Please rate the applicant in the areas below.Asks Clarifying Questions:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Understands the Difference in Friends & Strangers:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Can Appropriately Handle Conflict with Another Person:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Can Communicate Needs:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Uses a Personal Email Account:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Hangs Outs with Friends:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Can Communicate Personal Identification:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Follows Written & Verbal Directions:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Sets Up Social Activities with Friends:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Can Communicate Through Phone and/or Text:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Community Access Please rate the applicant in the areas below.Uses Pedestrian Safety Skills:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Uses Good Judgement in an Emergency:(Required)(i.e. fire alarm, tornado sirens, etc.) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Navigates Stores in Search of Needed Items:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Able to Utilize Public Transportation Independently:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Can Orient Themselves To and From Nearby Locations by Walking/Operating a Wheelchair:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Learning Please rate the applicant in the areas below.Can Use a Calculator:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Can Count Bills/Change:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Can Use a Debit/Credit Card:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Can Read & Comprehend Basic Instructions:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Can Navigate the Internet:(Required) Full Assistance Moderate Assistance Minimal Assistance Independent I Don't Know Not Applicable Please describe the applicant's math abilities:(Required)Please describe the applicant's reading abililties (include any assistive technology that is used on a daily/regular basis):(Required)Please describe the applicant's writing/composition abilities (include any assistive technology that is used on a daily/regular basis):(Required)Please describe the applicant's communication abilities (include any assistive technology that is used on a daily/regular basis):(Required) Applicant QuestionnaireThis questionnaire is to be independently filled out by the applicant. We encourage parents, guardians, or support personnel to allow the applicant to show his/her true capabilities in this section.Why do you want to attend Erskine Green Training Institute?(Required)Besides learning more about the training program you’ve selected, what skills do you want to acquire?(Required)What is one goal you want to reach after you complete the program?(Required)Have you ever spent time away from home? If so, what has been the longest time you’ve been away?(Required)What activities are you looking forward to while living at the hotel?(Required)If you hang out with friends, what do you like to do together?(Required)List any community activities you are involved in or enjoy on a regular basis.(Required)How do you learn best (i.e. small group, 1:1, large group, quiet environment, etc.)?(Required)In high school, what accommodations and/or modifications do/did you need?(Required)If you have been out of high school for more than three months, how do you spend your time?(Required) Housing Exemption Request FormI am requesting a housing exemption for the following reason: I will be living with my parent(s) or guardian(s) full-time in their primary residence that is within 60 miles radius of Erskine Green Training Institute and am including: Copy of a Current Utility Bill & a Valid Driver's License I live on my own in my primary residence that is within 60 miles radius of the Erskine Green Training Institute and am including: Copy of a Current Utility Bill & a Valid Driver's License I have primary custody of a child and am including: Copy of a Custody Order & State Issued Birth Certificate Identifying the Parent by Name I am in a marriage recognized by the State of Indiana and am including: Copy of a Marriage Certificate Upload Housing Exemption File(s):Please include required documentation as outlined above with your application. Drop files here or Select files Accepted file types: jpg, png, pdf, doc, Max. file size: 50 MB. Housing Exemption AcknowledgementI have read the housing Exemption Policies and verify that the information I’ve provided is accurate and copies of the required documentation are included with my application packet. I Acknowledge the Housing Exemption Statement AboveStudent's Signature:DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Guardian's Signature (if applicable):DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Application Fee PaymentApplication Fee: Price: Payment Options:(Required) Credit Card Check Money Order Total Credit Card(Required) DiscoverMasterCardVisaSupported Credit Cards: Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name Please make check or money order payable to The Arc of Indiana Foundation, Inc. Send your payment to: The Arc of Indiana Attn: Dawn Beck 143 W Market St Suite 200 Indianapolis, IN 46204Untitled First Choice Second Choice Third Choice
