Arkansas Transition Services - Arkansas Transition Services

Arkansas Transition Services Presents
Film Camp 2025

• April 21 - 25, 2025
• University of Arkansas Pulaski Technical College (UAPTC)
3000 W. Scenic Dr.
North Little Rock, AR
• $75 registration fee to help cover materials/meals
• Open to High School Juniors/Seniors with a disability

A limited block of rooms has been reserved at the Wyndham Riverfront for $110/night (+ taxes). Reservations can be made by calling 501.371.9000 (be sure to mention you're with the ATS Film Camp) or online by clicking here. Reservations must be booked before April 4 to get these rates. Payment for these rooms is the responsibility of the person reserving. No adult supervision is provided outside of camp hours and will not be provided for any students needing accommodations at the hotel. For those staying at the Wyndham Riverfront, free shuttle service will be provided to UAPTC and back to the hotel each day. **If you make hotel reservations before your registration is accepted, please make sure the reservations are refundable (in case we don't get to your name on the waitlist).

** ALL APPLICATIONS MUST BE COMPLETED ONLINE**
For further information, contact Bonnie Boaz at bonnie.boaz@ade.arkansas.gov or (501) 375.6487.

A teacher or parent may need to help complete this application. Film Camp registration is limited (50). Applicants will be reviewed and accepted on a first come, first served basis (as long as criteria is met). Priority registration will be given to first time attendees. If you have attended Film Camp on-site previously and want to attend again, you must apply now and you will be placed on a waitlist at the time of application. After the deadline, April 1, we will determine if there are open slots for second year attendees. If you are on the waitlist you will be notified of acceptance and will need to confirm acceptance by April 4.

Student Name(*)

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Gender(*)

MaleFemale

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Student Age(*)

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Street Address(*)

City(*)

State(*)

Zip Code(*)

District(*)

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Current Grade(*)

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High School(*)

School Phone Number(*)

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Student Email Address(*)

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Parent/Guardian Name(*)

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Parent/Guardian Primary Spoken Language(*)

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Parent/Guardian Email Address(*)

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Best Parent/Guardian Phone Number(*)

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What is the best way to communicate with you?(*)

Call Parent/Guardian

Text Parent/Guardian

Email Parent/Guardian

Call Student

Text Student

Email Student

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Please list the name of the appropriate teacher we can contact if more information is needed(*)

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Please enter first and last name.

Teacher's Email Address(*)

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Is the person helping complete this application someone other than the student/guardian/teacher listed above?(*)

YesNo

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Email Address of Person Helping Student Complete Application

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Tshirt Size(*)

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Ethnic Group(*)

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Disability Category (Please select all that apply.)(*)

Autism

Deaf-Blindness

Emotional Disturbance

Intellectual Disability

Multiple Disabilities

Orthopedic Impairment

Traumatic Brain Injury

Other Health Impairment

Specific Learning Disability

Speech or Language Impairment

Visual Impairment (Including Blindness)

Hearing Impairment (Including Deafness)

Other (Please list below)

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Other Disabilities(*)

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Dietary Restrictions/Allergies

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Requested Accommodations Needed

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Describe the applicant's interests and current educational program.(*)

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(Favorite activities, topics of interest, school program, community program, in school and/or private therapies, etc.)

Does the applicant have a full or part time aide at school?(*)

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No one-on-one aides or personal care is provided at Film Camp.

If yes, what type of services does the aide provide?(*)

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Will the student's aide be attending this film camp?(*)

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How does the applicant understand and interpret information?(*)

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(Reads, uses written notes to assist with auditory understanding, write, uses picture schedule or written schedule, etc.)

Does the student communicate conversationally?(*)

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If not, how does the applicant communicate?(*)

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What support(s) help the applicant communicate more effectively?(*)

Verbal Prompts

Pictures

Written Text

Other (please list below)

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Does the applicant demonstrate any challenging behaviors?(*)

YesNo

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(e.g. aggression towards classmates/adults, leaving areas without permission, tantrums, fighting, verbal abuse, refusing to complete work, verbal outbursts, self-harming)

Indicate which challenging behavior(s):(*)

Aggression towards classmates/adults

Leaving areas without permission

Tantrums

Fighting

Verbal abuse

Refusing to complete work

Verbal outbursts

Self harming (e.g. banging head on wall/table)

Other (please list below)

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Other Challenging Behavior(*)

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What strategies work well with these challenging experiences?(*)

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Are there known triggers of these behaviors of which we should be aware?(*)

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Does the applicant have a Behavior Intervention Plan?(*)

Yes (Please upload below.)No

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If no Behavior Plan exists, please describe the frequency of support, how support is provided, if assistants are present/what they do(*)

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Please upload Behavior Plan(*)

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Does the applicant...?(*)

Stay on Topic of Other's Interests

Ask Questions

Ask for More Information

Discuss Topics of Own Interest

Make Comments About What Others Say

Regularly Attend Classes

Participate in Group Conversation

Contribute to a Large Group

Accept Feedback

Stay on Track with Task

Listen to Other's Opinions

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Please list how the student will be transported to Film Camp each day. (Name of person transporting student)(*)

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Phone Number(s) of Person(s) Transporting Student(*)

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Will you be reserving a hotel room for the week you attend camp? **(*)

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Payment for these rooms is the responsibility of the person reserving. No adult supervision is provided outside of camp hours (10 a.m. - 4:30 p.m.) and will not be provided for any students needing accommodations at the hotel.

**If you choose to make hotel reservations prior to receiving acceptance email, please make sure the reservations are refundable.

Is the district sponsoring the applicant's attendance at the Film Camp?(*)

YesNo

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Consent(*)

I understand that I will be responsible for providing lodging, transportation, meals other than snacks and lunch provided at the camp, and supervision of the student outside of camp hours (10 a.m. - 4:30 p.m.). Campers must be picked up by 4:30 p.m. each day.

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Please upload a photo of the student.(*)

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After completing this form, please download the forms here, complete and return by email to jennifer.bibel@ade.arkansas.gov or fax to 501.375.6488. You will receive a confirmation email once you submit this form with the link to download the forms as well.

For fundraising ideas, click here

Enter the letters you see in the field provided(*)

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If you are having issues submitting the form, please contact jennifer.bibel@ade.arkansas.gov.