2016 Scholar Application Form

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NATIVE AMERICAN and INDIGENOUS SCHOLARS COLLABORATION PROJECT
Preparing Related Services Personnel School Psychologists and School Counselors to Serve Native
American Youth with Disabilities and at Risk of Mis-Identification
2016 SCHOLAR APPLICATION FORM*
NAME
______________________________________________ Red ID ___________________________
ADDRESS _____________________________________________________________________________
______________________________________________________________________________________
CITY, STATE, ZIP________________________________________________________________________
E-MAIL
____________________________________
GRADUATE PROGRAM:
___ SCHOOL PSYCHOLOGY
MONTH/YEAR OF EXPECTED GRADUATION:
Mobile Phone: _______________________
___ SCHOOL COUNSELING
________________________________
Please provide:

A letter of interest that includes a personal statement (two to three pages) outlining: (1) your
commitment to learning appropriate service to Native American children, youth and families in special
education and at risk of being misidentified for special education, and (2) why you believe you are a
strong candidate to become a Scholar on the NAISC Project,

Your current resume or vita, and

This cover sheet with the information above complete and the affidavit signed (yes you may sign, scan
and email).

Please TITLE the documents you send using your last name, NAISCP, and either the word Cover or
the words Statement or Vitae. You can also create one PDF file and send the entire application as one
document.

Email your complete application to Dr. Carol Robinson-Zañartu, Director at
[email protected] on or before March 18, 2016.
AFFIDAVIT
I have been informed about the nature and requirements of the projects. If accepted, I agree to participate in
the Summer Institutes, the project seminar associated with the project, fieldwork with Native youth,
professional conferences, and to complete the accountability portfolio at the end of each project semester. I
understand that I must remain a student I good standing to receive continuing support. I also understand that
repayment of the financial support I receive is waived under the condition that following graduation, I work in
education in the field for which I am being prepared for two years for each year of support I receive.
SIGNATURE
Date
_________________________________________________________
__________________________________________
The Native American and Indigenous Scholars Collaboration Project is a
Pre-service Personnel Preparation Grant
Supported by the US Department of Education
Office of Special Education Programs
H325K140409 2011-2015
* Applications for participation in this project are normally accepted AFTER you have been accepted to one of the graduate programs
(School Counseling or School Psychology).
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