2026 Summer Program Application

2026 Project SEARCH Black Hills Application
Nondiscrimination

It is the policy of Black Hills Special Services Cooperative (BHSSC) not to discriminate on the basis of any protected group status in its educational programs, activities, or employment policies and activities as required by following state and federal laws and regulation. Inquiries regarding non-discriminatory policies may be directed to the BHSSC Title IX Coordinator or to the South Dakota Regional US Office for Civil Rights listed below.
South Dakota Regional US Office for Civil Rights

1961 Stout Street Room 08-148 Denver, CO 80294 Fax: (202) 619-3818 TDD: (800) 537-7697 Email: ocrmail@hhs.gov

Application Purpose & Guidelines

This application will help identify and outline the Project SEARCH student’s skills and abilities. This provides the information necessary for the Selection Committee to assess the candidate’s skills, abilities, and background. The Selection Committee may establish contact with the student, parents or legal guardians, past, present, or current employer, in addition to previous school faculty, e.g., principals, teachers, and counselors, to collect, confirm or validate additional information. Information will be used to identify and satisfy eligibility criteria for program acceptance. The goal is to identify students who will benefit from the Project SEARCH program, and to achieve competitive employment for 100% of the students.
Project SEARCH Selection Criteria
- Committed to work competitively in the community at the conclusion of the Project SEARCH program.
- Be at least 18 years of age.
- Has met high school completion requirements.
- Agree that this will be the last year of student services provided by their resident district.
- Must be on an Individual Education Plan (IEP) with their resident school district.
- Must be on an Individual Plan for Employment (IPE) with Vocational Rehabilitation.
- Have independent personal hygiene and grooming skills.
- Have independent daily living skills.
- Demonstrate workplace behavior and social skills.
- Take direction from supervisors.
- Be able to communicate effectively.
- Arrange transportation independently.
- Provide up to date immunizations records.
Project SEARCH Selection Criteria*

By checking this box, I acknowledge that I have read and meet the selection criteria.
Project SEARCH Selection Process
1. All students are encouraged to attend a pre-application meeting. Students must visit the host business site to observe the culture, possible rotations, meet the instructor and job coaches before acceptance into the Project SEARCH Program;
2. Late applicants must meet all entrance criteria and will be discussed by the selection committee on a case-by-case basis;
3. Out-of-state applicants may be considered by the selection committee on a case-by-case basis, unless we are at capacity to serve students from South Dakota. The home state school district and home state VR (or an alternate source) will have to provide appropriate funding;
4. Submit the online application form;
5. The Selection Committee members will receive a copy of each application. Applications will be reviewed to determine if the student’s interests and skills align with the goals of the Project SEARCH Program;
6. Once the application is received, an interview will be set up with the student and guardian (if applicable) and the Selection Committee, along with an informal skills assessment;
7. If selected for participation in Project SEARCH, an IEP will be developed with the IEP team for the upcoming RCAS school calendar year.
Project SEARCH Selection Process*

I understand and agree to the selection process described above.
Project SEARCH Application Packet Checklist
1. The Completed Application;
2. The Current Individual Education Plan (IEP), with Transition Goals;
3. The Current (Transition Assessment) Multidisciplinary Team Report and Determination of Special Education Services;
4. The Applicant’s high school transcript or the records from the most recent high school
Project SEARCH Application Packet Checklist*

I have reviewed the checklist and confirm that all required documents are to be uploaded in this form.
Upload the required documents below.
Email projectsearch@bhssc.org for assistance if needed.
Current IEP with Transition Goals*

Cancelof
Current Multidisciplinary Team Report*

Cancelof
List of Documents to Provide Upon Acceptance
1. Proof of Health Insurance (SSI or SSDI determination, if applicable);
2. Copy of birth certificate;
3. Copy of Social Security card;
4. Copy of guardianship papers (if applicable)
5. Current Immunization Records or Copy
List of Documents to Provide Upon Acceptance*

I understand that additional documents will be required upon acceptance and agree to provide them as requested.

Student Information
Student Name *

First NameLast Name
Date of Birth*

MonthDayYear
Date
Gender*
Residential Address*

Street Address

Street Address Line 2 (Unit/Apt #)

CityState / Province

Postal / Zip Code
Student Cell Phone*
Please enter a valid phone number.

Primary Parent/Guardian Information
Primary Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2 (Unit/Apt #)

CityState / Province

Postal / Zip Code
Primary Email *
example@example.com
Primary Parent/Guardian Cell Phone*
Please enter a valid phone number.
Workplace
to contact in case of emergency
Work Email
example@example.com
Work Phone
Please enter a valid phone number.
Is there a secondary Parent/Guardian?*

YesNo
Secondary Parent/Guardian Name

First NameLast Name
Relationship to Student
(i.e. Father, Mother, Grandparent, etc.)
Cell Phone
Please enter a valid phone number.
Is address for Secondary Parent/Guardian same as above?

YesNo
Address (if different from above)

Street Address

Street Address Line 2 (Unit/Apt #)

CityState / Province

Postal / Zip Code
Workplace
to contact in case of emergency
Work Email
example@example.com
Work Phone
Please enter a valid phone number.
Is the applicant his/her own legal guardian?*

YesNo
Legal Guardian's Name

First NameLast Name

Note to Students and Parents/Guardians

Final placement into Project SEARCH will depend upon the Individual Education Plan (IEP) meeting and the Selection Committee. Final placement is also dependent on completion of an Individualized Plan for Employment (IPE), with VR. The student will seek competitive employment before the end of the current RCAS calendar school year.
RELEASE OF RECORDS: {pupilsName33}

The records for the student identified above may be transferred to Project SEARCH, their representatives, and to members of the Selection Committee, from his/her School of Residence to establish eligibility, and potential acceptance, pending review. The student will complete a release with VR to allow the transfer of pertinent medical information used to determine eligibility for VR services.
Student Consent*
Today's Date

MonthDayYear
Date
Primary Parent/Guardian Consent*
Today's Date

MonthDayYear
Date

School District Information
1. School District of Residence:*
District, not school
2. School/Transition Program Currently Attending:*
School or transition program you are currently attending

Employment Information, Work History, and Preferences
Do you have any work history?*

YesNo
Since you selected No for work history, you can scroll and click Next to continue.
1. Employer
Employer Phone
Please enter a valid phone number.
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor's Name

First NameLast Name
Job Title
Wage paid
per hour
Employment Start Date

MonthDayYear
Date
Employment End Date

MonthDayYear
Date
Job Duties:
Is this a Project Skills job?

YesNo
Do you have additional employment experience?

YesNo

2. Employer
Employer Phone
Please enter a valid phone number.
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor's Name

First NameLast Name
Job Title
Wage paid
per hour
Employment Start Date

MonthDayYear
Date
Employment End Date

MonthDayYear
Date
Job Duties:
Is this a Project Skills job?

YesNo
Do you have additional employment experience?

YesNo

3. Employer
Employer Phone
Please enter a valid phone number.
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor's Name

First NameLast Name
Job Title
Wage paid
per hour
Employment Start Date

MonthDayYear
Date
Employment End Date

MonthDayYear
Date
Job Duties:
Is this a Project Skills job?

YesNo

Medications

Prescription Medications. Project SEARCH does not monitor or administer medications.
Number of prescription medications*
1. Medicine Name
2. Medicine Name
3. Medicine Name
Over-the-Counter Medications currently taking:*
Put none if there are none.
List any health or medical issues that may impact a successful job placement:*
Put none if there are none.
Please list any limitations that may impact an internship rotation or employment:*
Put none if there are none.
Severe Allergies
Do you have any severe allergies such as latex, bees, peanuts, gluten, or shellfish that we should be aware of?*

YesNo
Please explain:

Service Agencies and Benefits
Do you have a Vocational Rehabilitation (VR) Counselor?*

YesNo
Counselor's Name

First NameLast Name
VR Counselor's Email
example@example.com
Business Phone
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Are you receiving any of the following? Skip any non-applicable items.

SSDISSIUnemployment

Behavioral Summary
Do you have any behaviors that might impact a successful job placement?*

YesNo
Please detail all behaviors and characteristics:

Why do you want to come to Project SEARCH, what are your goals, and what outcome do you hope to achieve?*
Provide three references (Not Family)
Reference 1*

First NameLast Name
Reference 2*

First NameLast Name
Reference 3*

First NameLast Name

If you are accepted into the Project SEARCH program you must abide by the terms and conditions outlined on page 8 of our Project SEARCH Intern Success Guide and will be required to sign a Student Participation Contract.

During Transition Week, participants will:
- Explore career interests and transferable job skills.
- Engage in teamwork, workplace safety, and independent living activities.
- Learn through interactive lessons inspired by our Project SEARCH internship model, helping prepare them for future employment opportunities.
This application has been completed by:*

First NameLast Name
Title:*
Phone*
Please enter a valid phone number.
Today's Date*

MonthDayYear
Should be Empty:

2026 Project SEARCH Black Hills Application

Application Purpose & Guidelines

Project SEARCH Selection Criteria

Project SEARCH Selection Process

Project SEARCH Application Packet Checklist

List of Documents to Provide Upon Acceptance

Student Information

Primary Parent/Guardian Information

School District Information

Employment Information, Work History, and Preferences

Independent Living

Medications

Severe Allergies

Service Agencies and Benefits

Behavioral Summary