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).