PASS Online Application PASS Application Student InformationStudent Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Date of Birth* Email* Phone*Parent/Guardian InformationParent/Guardian Name First Last PhoneEmail Parent/Guardian Name First Last PhoneEmail Medical InformationAge of Initial Autism Spectrum Diagnosis:*Other Psychological or Psychiatric Diagnoses (N/A if None):*List AllergiesList Dietary RestrictionsList MedicationsAcademic InformationHave you taken the ACT/SAT*YesNoIf so, what score did you receive?What accommodations, if any, did you receive?What is your GPA (Current UTK Students)?HistoryThe following items are to be completed by the student applying for admission to the program.Support Services:*Use the space above to describe what type of support services you have received in the past or are currently receiving and how have they helped you? (For example, tutoring, speech/language service, occupational therapy, counseling, etc.)Clubs/Groups:*Use the space above to let us know what clubs or groups, if any, you have been involved with during high school and/or college.Why the University of Tennessee:*Use the space above to describe why you want, or wanted, to come to the University of Tennessee.Major:*Use the space above to let us know if you have decided on a major, what that major is, and if not decided yet, what majors interest you the most.Future:*Use the space above to describe what you think your life will be like in five years academically, occupationally, and personally.Personal StatementMy academic preferences/strengths:*Use the space above to describe your personal academic preferences and/or strengths.My academic challenges:*Use the space above to describe your personal academic challenges.My social strengths:*Use the space above to describe your personal social strengths.My social challenges:*Use the space above to describe your social challenges.Which life skills are you currently responsible for (cleaning room, cooking, managing medication, managing dietary restrictions, etc.):*Areas of general interest include:*Personal EssayPlease type and upload a double-spaced, one-page essay describing how having an Autism Spectrum Disorder has impacted your life, relationships, and experiences.Personal Essay Upload:*Autism Spectrum Disorder DocumentationPlease upload the most recent psychological or psychoeducational evaluation that documents your Autism Spectrum Diagnosis (Needs to be within the last 3-5 years) if you have one. If you don't have the documentation, you may need to have an evaluation completed prior to being considered for admission.Autism Documentation Upload