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The College Experience
A 2-year Program for Young Adults with Intellectual Disabilities
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Home
Learn More
About Us
Schedule Chat
Message From Our Executive Director
Questions & Answers
Our Staff
Success Stories
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Blog
Contact & Apply
Contact Us
Apply
Private Pay
Medicaid Waiver
Academics
Academic Overview
Academic Calendar
Course Catalog
Core Courses
Electives
Internships/Job Experience
Residential
Living Arrangements
Neighborhood and Community
Supportive Presence
Visit and Dorm Entry Forms
Events
Student Events Calendar
College Fairs, Conferences and Events
Donate
Request to Visit a Student Residing in 790, 830 or 839
PLEASE MAKE YOUR REQUEST 72 HOURS IN ADVANCE OF YOUR PLANNED VISIT.
NOTE: By completing the form below, you are acknowledging the risks involved for all entering the dorm and the possible exposure it allows for.
Name of student being visited
*
First
Last
Will your visit take place in the student’s bedroom or outdoors?
*
Indoors
Outdoors
Residential address of student you are requesting to visit
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Building
*
790
839
830
Untitled
Service 2
Time of Visit
*
March 2023
Sun
Mon
Tue
Wed
Thu
Fri
Sat
1
2
3
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31
March 25, 2023
8:00 AM
9:30 AM
11:00 AM
12:30 PM
2:00 PM
3:30 PM
5:00 PM
6:30 PM
8:00 PM
March 26, 2023
8:00 AM
9:30 AM
11:00 AM
12:30 PM
2:00 PM
3:30 PM
5:00 PM
6:30 PM
8:00 PM
March 27, 2023
8:00 AM
9:30 AM
11:00 AM
12:30 PM
2:00 PM
3:30 PM
5:00 PM
6:30 PM
8:00 PM
March 28, 2023
8:00 AM
9:30 AM
11:00 AM
12:30 PM
2:00 PM
3:30 PM
5:00 PM
6:30 PM
8:00 PM
March 29, 2023
8:00 AM
9:30 AM
11:00 AM
12:30 PM
2:00 PM
3:30 PM
5:00 PM
6:30 PM
8:00 PM
March 30, 2023
8:00 AM
9:30 AM
11:00 AM
12:30 PM
2:00 PM
3:30 PM
5:00 PM
6:30 PM
8:00 PM
March 31, 2023
8:00 AM
9:30 AM
11:00 AM
12:30 PM
2:00 PM
3:30 PM
5:00 PM
6:30 PM
8:00 PM
Name of person requesting visit (this person will receive the appointment confirmation email)
*
First
Last
Email of person requesting visit
*
Name of first visitor
*
First
Last
Relationship to Student
Visitor’s address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Are you vaccinated?
*
Yes
No
Have you submitted a copy of your COVID-19 Vaccination card to Colleen Dergosits? If no, please submit a copy following this form if you are vaccinated
*
Yes
No
Is this person under the age of 18?
*
Yes
No
Will there be additional visitors?
*
No
Yes
Name of second visitor
*
First
Last
Relationship to Student
Second visitor’s address
*
Same as first visitor
Different from first visitor
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Are you vaccinated?
*
Yes
No
Have you submitted a copy of your COVID-19 Vaccination card to Colleen Dergosits? If no, please submit a copy following this form if you are vaccinated
*
Yes
No
Is this person under the age of 18?
*
Yes
No
Will there be additional visitors?
*
No
Yes
Consent
*
We agree that by bringing a third visitor that we understand our visit must be outdoors only.
Name of third visitor
*
First
Last
Relationship to Student
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Is this person under the age of 18?
*
Yes
No
All visitors must answer the following questions. Please certify this is true by completing this form.
Have any of the visitors listed above been around someone who has COVID-19 in the past two weeks?
*
Yes
No
Rules for Visitation:
After your request is approved, all members must complete the
Day of Arrival Guest Screening Form
found on the website and submit prior to entering. It requires all guests entering to take their temperature the morning of arrival and certify that it is less than 100 degrees.
If anyone has a temperature of 100 degrees or higher they will not be permitted to visit that day
All visitors must wear a facemask at all times while visiting in the dorms.
If visitation can be held outdoors, this is preferred and appreciated.
Disclaimer
By submitting this information, I certify that I have read and agree to the rules and regulations being required for all visitors. I understand there are risks involved for all by entering the residential facility. I am aware the individual has to accept my request to visit knowing the possible risks.
Consent
I agree to the privacy policy.
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First
Last
Email
*
Phone
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