University of California-Leadership Education in Neurodevelopmental Disabilities

UC-LEND Trainee Application

NOW ACCEPTING APPLICATIONS

All individuals interested in becoming medium- and long-term trainees must complete this application. Please complete the form below to apply for the 2019-20 UC-LEND Training cycle.

*Eligibility for a stipend includes acceptance into UC-LEND as a long-term trainee, U.S. Citizen, and enrolled students at a 4-year institution.

Applications are due May 17, 2019. Letters of Recommendations are due May 31, 2019. Applicants will be notified of their application status by 5 pm on June 7, 2019.

Participant Info
First Name
Middle Initial
Last Name
Affiliation	UCLA UCR other:
Discipline or Academic Department
Expected Graduation Term	If applicable
Applying For	Long-term Medium-term
Date of Birth
Sex	Female Male Other Prefer Not To Disclose
I am a:	U.S. Citizen Permanent Resident/Green Card Holder other:
Race	White or Caucasian Hispanic or Latino or Spanish Origin Black or African-American Asian Native American or Alaska Native Middle Eastern or North African Native Hawaiian or Other Pacific Islander Prefer not to respond other: Response optional and for demographic tracking/reporting purposes only (please select “Prefer Not To Respond” if you do not wish to provide this information). Please select all that apply.
I am a:	Person with a disability or special health care need Parent of a person with a disability or special health care need Family member of a person with a disability or special health care need Not applicable Prefer not to respond Response optional and for demographic tracking/reporting purposes only (please select “Prefer Not To Respond” if you do not wish to provide this information). Please select all that apply.
Email
Phone	Please enter phone number in following format: 310-555-5555
Primary Language
Additional Languages
CV	Please upload your CV in PDF (preferred) or Microsoft Word format. NOTE: Please use the following convention to name your file: LastName, FirstName.CV.pdf or LastName, FirstName.CV.doc
Personal Statement	Please upload your Personal Statement in PDF (preferred) or Microsoft Word format. Please make sure that you address the two writing prompts and designate them as separate sections of your statement: 1) In 300 words or less, please describe the personal and professional qualities you use to define or describe leadership; and 2) In 300 words or less, please discuss how you hope the UC-LEND long term traineeship will shape or impact your graduate training. NOTE: Please use the following convention to name your file: LastName, FirstName.Statement.pdf or LastName, FirstName.Statement.doc
Only For Long-Term Trainee Applicants: Unofficial Transcript	Please upload your unofficial transcript in PDF format. NOTE: Please use the following convention to name your file: LastName, FirstName.Transcript.pdf or LastName, FirstName.Transcript.doc
Only For Long-Term Trainee Applicants: Recommendation Forms	I understand that my application will be incomplete and will not be reviewed until the UC-LEND coordinator receives two (2) recommendation forms (either via direct email from your references to [email protected] or via delivery to 10960 Wilshire Blvd, Suite 960, Los Angeles, CA 90024).
I Am Not A Robot	10 − 5 = ? Please solve the simple math question above to prove that you are not a robot.

NOW ACCEPTING APPLICATIONS

Participant Info