PASS Online Application

PASS Application

Student Information
Student Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Date of Birth*
MM slash DD slash YYYY
Email*
Phone*
Parent/Guardian Information
Parent/Guardian Name
First Last
Phone
Email
Parent/Guardian Name
First Last
Phone
Email
Medical Information
Age of Initial Autism Spectrum Diagnosis:*
Other Psychological or Psychiatric Diagnoses (N/A if None):*
List Allergies
List Dietary Restrictions
List Medications
Academic Information
Have you taken the ACT/SAT*
If so, what score did you receive?
What accommodations, if any, did you receive?
What is your GPA (Current UTK Students)?
History
The 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 Statement
My 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 Essay
Please 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:*
Max. file size: 1 MB.
Autism Spectrum Disorder Documentation
Please 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
Max. file size: 1 MB.

The University of Tennessee, Knoxville

Korn Learning, Assessment, and Social Skills Center College of Education, Health & Human Sciences

PASS Online Application

PASS Application

Student Information

Parent/Guardian Information

Medical Information

Academic Information

History

Personal Statement

Personal Essay

Autism Spectrum Disorder Documentation