CUNY Unlimited is a credential program in development through a grant partnership with AHRC New York City, the City University of New York, the JFK, Jr. Institute for Worker Education, the New York City Department of Education, and the University of Rochester. It is offered at five CUNY campuses for students with intellectual disabilities: with AHRC New York City’s Melissa Riggio Higher Education Program at the Borough of Manhattan Community College, the College of Staten Island, Hostos Community College, and Kingsborough Community College; and with the New York City Department of Education’s District 75 Inclusion Program at Queens College. For more information, visit www.cuny.edu/unlimited.

If you are applying to AHRC New York City’s Melissa Riggio Higher Education Program at the City University of New York in partnership with the new CUNY Unlimited credential program, please use this form as a Cover Sheet when sending us items by mail. Applicants must submit all Supplemental Application Materials directly to AHRC New York City’s Referral and Information Center as Part 2 of the application process. For more information about Part 2, visit the Melissa Riggio Higher Education Program page at www.ahrcnyc.org/services/school/college/apply.

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Mailing Street Address (If different from your residential address)

City State Zip Code

Residential Street Address (Where you are living right now)

City State Zip Code

First Name Middle Initial Last Name

Email Address

Primary Phone Number Secondary Phone Number

Signature of Applicant Date

AHRC New York City reaffirms its policy of equal opportunity and does not discriminate against any applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and the basis of disability or any other federal, state or local protected class.

Check All Items Enclosed

Individualized Education Program (IEP)

Psychological Evaluations (At least two evaluations from the requested list)

Psychosocial Evaluation

Recommendations (Two recommendations in sealed & signed envelopes from the recommenders)

Medical History Self-Report

Individual Authorization for Release of Protected Health Information (HIPAA-2)

Other:

Applicant Information

Send Part 2 documents by mail only to AHRC New York City | Referral and Information Center | Attn: Melissa Riggio Higher Education Program | 83 Maiden Lane | New York, NY 10038.

The Application Deadline for Fall 2020 Admission is December 1, 2019.

Cover SheetS u p p l e m e n t a l A p p l i c a t i o n M a t e r i a l s