New 2025 PALS Application

The Arc Gateway PALS

4585 Isabella Ingram Drive, Pensacola, FL 32504

2025 PALS Application

PALS Student Application Information

The Arc Gateway Program for Adult Learning and Support (PALS) is designed for individuals whose academic, social, communication, and adaptive skills are affected due to a disability. Most applicants would have received special education services in the K-12 setting and exited their secondary school with a diploma, GED or certificate of completion.

PALS is a career certificate program (not an accredited college degree program). Students will exit their chosen training program with a certificate and potentially an industry recognized certificate depending on their chosen career path.

A completed application and appropriate documentation must be submitted on or before the deadline. An incomplete application will delay the review process. It is acceptable for the applicant to receive support in completing the application. All information will be kept confidential and will not be shared without written permission from the applicant or their legal guardian.

Online applications are preferred; however, printed applications will be accepted if received at the following address on or before the deadline:

The Arc Gateway PALS
4585 Isabella Ingram Drive
Pensacola, FL 32504

Material submitted becomes property of The Arc Gateway and will not be returned. Not all applicants who complete the application and meet the criteria listed and/or eligibility will be accepted into The Arc Gateway PALS. An Admissions Committee will review all applications and invite selected applicants to an interview and informal assessment. This does not guarantee acceptance into The Arc Gateway PALS. Once interviews are complete, selected applicants will receive a letter notifying them of their acceptance. In their acceptance letter, they will receive information and any additional application paperwork or procedures.

Vocational Rehabilitation is a requirement for program admission.

Questions? Call (850) 466-2521 or email pals@arc-gateway.org.

Please note that application guidelines and eligibility requirements are subject to change.

Apply now for the Spring or Fall 2025 semester! Seats fill up fast so be sure to take advantage of our early admission process.

The deadline to apply for the Spring 2025 semester is November 15, 2024.

The deadline to apply for the Fall 2025 semester is July 15. 2025.

Enroll In

Preferred Name

First Name

Middle Name

Last Name

Last Initial

Birth Date

Social Security Number

Cell Phone

Home Phone

Gender

Ethnicity

Street

City

State/Province

Zip/Postcode

Student lives with

Student 's Legal Rights

Name of court appointed legal guardian(s):

Include copy of court guardianship documentation

Student Supports (check all that apply)

Division of Vocational Rehabilitation

If yes, who is your VR Counselor?

Receiving services from the Agency for Persons with Disabilities (APD)

On the waiting list for services with APD

Whether receiving services or on the waitlist, who is your APD Coordinator?

Supplemental Security Income (SSI) and/or Social Security Disability Income (SSDI)

Primary Emergency Contact Information

Contact Name

Relationship

Email Address

Cell Phone

Home Phone

Work Phone

Secondary Emergency Comtact Information

Contact Name

Relationship

Email Address

Cell Phone

Home Phone

Work Phone

Disability Eligibility Information

Learning Difficulties

Yes No

Learning Difficulties Description

ESE Information

If other, please describe:

Education & Career Training

List past educational and/or career training programs you have attended, starting with the most recent.

School Attended (Most current)

Years Attended

School Attended (Previous)

Years Attended

School Attended (Additional)

Years Attended

Do you have a High School Diploma or GED?

Please describe your academic strengths and weaknesses.

How do you think you learn best? (e.g.: small groups, extra time, etc.)

In the following areas, describe what skills you would like to learn: Independent Living

Academics

Social/recreational/leisure

Employment

What accommodations did you receive in educational settings?

What assistive technology have you used in educational settings?

Which of the following best describes the educational setting you experienced in high school?

PALS Career Certification

The Arc Gateway PALS offers a variety of certification options with coursework ranging between one and three semesters. Applicants must choose their career certification track prior to entering the program.

Choose a career certification track from the following:

Work Experience

List work or volunteer experiences in chronological order, starting with your most recent job.

Name of Business (Most Current) & Supervisor

Paid/Unpaid

Rate of Pay

Hours per week

Job Responsibilities

Reason for leaving

Name of Business & Supervisor

Paid/Unpaid

Rate of Pay

Hours per week

Job Responsibilities

Reason for leaving

Name of Business & Supervisor

Paid/Unpaid

Rate of Pay

Hours per week

Job Responsibilities

Reason for leaving

Transportation Information

Based on available funding, The Arc Gateway PALS will provide transportation for people living in most areas of Escambia and Santa Rosa counties.

Do you require wheelchair accessible transportation?

Yes No Not Selected

If wheelchair accessible transportation is not available, are you able to transfer?

Yes No Not Selected

Do you have an alternate transportation plan to allow for recreational, social, and job opportunities occurring before 8:00am, after 3:00pm and on weekends?

Yes No Not Selected

List any limitations, support needs, or related issues impacting your transportation.

Medical Information

1. Give a brief description of your medical history, including disability diagnoses.

2. List any significant medical, psychiatric, behavioral, and/or physical conditions that may impact your participation in classroom, social, or recreational activities on campus, including allergies.

3. List any current medications you are taking. If you must take medications while on campus, you must be independent in self-administering the medications.

4. Provide any other medical information that you feel would be important regarding your participation in this program.

Student Questionnaire

1. I am really good at and/or enjoy:

2. My dream job would be:

3. Two personal goals I want to achieve include:

4. Are you now or have you ever been charged with or subject to a disciplinary action for misconduct at school?

Yes No Not Selected

If yes, please explain

5. Have you ever been convicted of a criminal offense or have charges pending of any criminal offense?

Yes No Not Selected

If yes, please explain

Copy of Official Documentation explaining the final deposition

Personal Support Inventory

This form may be completed by the student and/or family support. "Not sure" may be used for items that are not applicable or lack personal information for rating.

Independent Living Skills

Person Completing Personal Support Inventory?

Finds way around new places

Prepares simple meals

Orders/purchases from a resaurant

Able to find items in a store

Manages personal belongings

Stays home alone

Takes public transportation

Follows personal hygiene regimen

Interpersonal Skills

Relates well with others

Asks for help or clarification

Use of judgement in an emergency situation

Copes well with stress or anger

Deals with conflict appropriately

Adjusts to new situations (change)

Engages in appropriate social interaction

Respects authority figures

Social Skills and Communication

Has friends of his/her own age

Communicates needs appropriately

Shares personal address, phone, etc.

Distinguish between friends and strangers

Uses cell phone for calls and texts

Academic Skills

Counts money

Stays in budget

Addition

Subtraction

Multiplication

Division

Reading

Writing

Uses a calculator

Navigates the internet

Uses computer for word processing

Follows verbal directions

Uses library

Follows written directions

Keeps daily schedule

Meets deadlines

Uses email

Release and Exchange of Information

As an adult, students enrolled in The Arc Gateway PALS are protected under HIPAA and FERPA. The Arc Gateway, Inc. will treat and regard all written documentation obtained to verify a disability and plan for appropriate services as confidential. However, it will be necessary for The Arc Gateway PALS personnel to exchange information about you with agency staff and others in order to provide appropriate educational opportunities and experiences. This exchange will occur only with written permission, as given by signing below, and with the understanding that only information necessary for the purposes of accommodation and academic progress will be communicated.

I give permission to exchange information about me to the following offices/individuals.

The Arc Gateway, Inc.

Agency for Persons with Disabilities

Pensacola State College

Division of Vocational Rehabilitation

School District (please enter below)

Other (please enter below)

If school district, please specify county and state

If other, please specify

Required Documents

Please download all the forms from the links below and upload the completed forms as an attachment. If you are unable to print or upload the forms, please contact The Arc Gateway PALS office for support at (850) 466-2521.

Admission Information
Memorandum of Understanding
Research Consent Form
Personal Statement
Release and Exchange of Information
Application Checklist

Birth Certificate

Identification

State ID, Driver License, Military ID

Copy of High School Diploma or GED

Copies of High School Transcripts

Copy of Most Recent Individual Education Plan (IEP)

Functional Behavior Assessment (If Applicable)

Psychological / Educational Assessment or Evaluation

Student / Parent / Guardian Memorandum of Understanding

Personal Statement

Research Consent Form

Copy of Social Security Card (Signed)

Enter the above code

Required