MOSSAIC Rolling Application

Q1. Mentoring, Organization, and Social Support for Autism/All Inclusion on Campus (MOSSAIC) is a program designed to support neurodiverse students on the UM and Missoula College Campuses.

At times, we have allowances to support people that do not attend U of M. We have limited availability for this program. Participants are selected based on need and past participation.

Please complete this application if you would like to participate in MOSSAIC

Q2. MOSSAIC participants fit a specific profile in terms of skills and needs. To be successful in MOSSAIC, you will need to meet the following criteria:

Live independently
Capable of attending school and meeting academic requirements independently
Fulfilling your basic needs of food, shelter, transportation, etc.

The MOSSAIC program provides direct speech/language services, Wednesday evening socials, and education for the Campus and Community to help others create neurodiverse inclusive spaces. If you require more support than this, you may wish to pursue other services beyond these offerings of the MOSSAIC program.

The University of Montana offers services through the Office of Disability Equity (ODE), Trio Services, and Curry Health Counseling Services on campus. Many MOSSAIC participants also access these services.

Q3. The applicant is required to complete this form. Caregivers may assist.

Q4. I have been accepted to (or anticipate being accepted to):

The University of Montana
Missoula College
Other:
I am not attending school

Q5. Today's Date:

Q6. Name, First and Last

Q7. Phone number of participant

Q8. Email Address (this must be the applicant's email address)

Q9. Local Address

Q10. Permanent Address (write n/a if not applicable)

Q11. Student ID (790 number)

Q12. Are you a current participant in MOSSAIC?

Yes
No