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Project Success
Nursing Education Building, Rm 26
Phone: (920) 424-1033
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Project Success Application


  • Personal Information

  • mm/dd/yyyy
  • (###) ###-####
  • mm/dd/yyyy
  • (Optional) Parents Names

  • Residency Status

  • mm/dd/yyyy
  • Information About Your Disability

  • mm/dd/yyyy
  • **Please send a copy of your most recent documentation with this application**

    Please provide the following information on the person who first or most recently diagnosed your learning disability or dyslexia:
  • mm/dd/yyyy
  • Please check the areas that are most difficult for you because of your disability:
  • High School Information

    Please provide the name and address of the high school where you graduated or are currently attending:
  • Postsecondary Education Information

  • mm/dd/yyyy
  • mm/dd/yyyy
  • 0.00
  • Application To-Do List

    Please make sure to include the follow when submitting the application:
  • mm/dd/yyyy
  • Project Success recommends applying to the program during second semester Junior year or first semester Senior year.