MT. DIABLO ADULT EDUCATION

ON TRACK PROGRAM FOR ADULTS WITH ACQUIRED BRAIN INJURY

ENTRANCE & CONTINUATION CRITERIA

Applicants:  Please read the following policies regarding entrance/continuation criteria.  Then complete and sign the bottom portion, keep the bottom copy, and return the other copies along with your application.  Recommendation for acceptance and continuation in the On Track Program is based on the student meeting all of the following eligibility requirements:

DIAGNOSIS
1.  Acquired Brain Injury (may include, but not limited to TBI, stroke, anoxia, aneurysm) - must be medically certified

      2.  Medical condition is not degenerative.

      3.  Does not have a primary diagnosis of developmental disability or chronic mental illness

GENERAL
1.  AGE:  at least 18 years old

2. Expresses an interest in participating in the program, and is sufficiently motivated to attend and participate on a

      regular basis.
3.  Demonstrates ability to benefit from the program.

      4.  Able to participate independently in a large group setting (without the need for 1:1 assistance, unless provides
     attendant)

      5.  Willing to meet the tuition requirements, or eligible for financial assistance.

COGNITIVE
1.  Able to follow simple directions.
2.  Oriented to environment.
3.  Has sufficient attention span and topic maintenance for group setting.

PSYCHO-SOCIAL
1.  Comfortable in group situations and has desire for increased socialization.
2.  Able to maintain behavior that is not continually disruptive to the group and does not physically endanger
     themselves or others.
3.  Behavior problems are mild (if any), and can be managed in a large group setting.
4.  If history of substance abuse, it is currently under control and treatment completed (i.e. Alcoholics Anonymous).
5.  Willing to seek counseling (outside the On Track program) if recommended by staff.
6.  Willing to comply with a behavioral contract (if necessary) developed together by staff and student.

PHYSICAL/MEDICAL
1.  Medically stable, and able to participate in a 4-hour program, as determined by physician.
2.  Able to manage own medication needs independently, if required during program hours (or provides attendant).
3.  Continent and able to attend to own personal needs and toileting (or provides attendant).
4.  If using a wheelchair, operates independently (or provides attendant)

Individuals requiring 1:1 assistance due to physical or behavioral needs must provide a personal attendant during program.  MDAE staff cannot provide assistance in eating, transferring, toileting or dispensing of medication.

I have read and understand the above entrance/continuation criteria.

            student signature                                     parent/caregiver/conservator, if applicable                     date

                                      White copy: On Track Staff         Pink Copy: Program Coordinator                      Yellow Copy: Student