Tara Reilly Scholarship Application

APPLICANT INFORMATION:

First Name
Last Name
Middle Initial
Address Type	Home Work
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone (format xxx-xxx-xxxx)
Home Phone (format xxx-xxx-xxxx)
Mobile Phone (format xxx-xxx-xxxx)
FAX (format xxx-xxx-xxxx)
E-mail
Confirm E-mail:
Training Institution
Department or College
Professional Area of Training	Special Education     Juvenile Justice     Mental Health     Other.  Please specify:
Anticipated Program Completion Date
Training Institution Address
City
State/Province
Zip/Postal Code
Country
Phone
Name of Contact at Institution (i.e., advisor, instructor, department office, registrar)
Institution Contact E-mail

LETTERS OF SUPPORT:

Applications require three (3) letters of support. All individuals writing letters of support should have knowledge of the candidate's skills related to potential success with troubled children and youth. Letters may be written by instructors, professors, advisors, professional supervisors and professional colleagues. Please indicate below who will be submitting letters on your behalf.  Letters may be submitted via email (to mknoll @ behavioralinstitute . org - remove spaces) or fax (651-483-3879). Letters of support should be submitted directly by the authors and not by the scholarship applicant.

Letter #1

Letter #2

Letter #3

PERSONAL STATEMENT:

Applications require a personal statement, no more than 500 words, describing your interest and motivation in working with troubled children and youth. This should include career goals and how this scholarship will help you in achieving your goals.

You may type or cut and paste your personal statement below. If you prefer, you may e-mail your personal statement as a word document or pdf.

WRITTEN PAPER:

Applications require an original paper that may be a) a research project; b) a critical analysis of a current issue in the literature; or c) a thorough description of an intervention/program that you have used successfully. It must address research-based practices and should be no less than 10 pages and no more than 20 pages, including references.  The following links may be helpful for following APA style: www.docstyles.com/apacrib.htm and http://owl.english.purdue.edu/owl/

Please submit your written paper via e-mail as a word document or pdf.

APPLICATION CHECKLIST:

Please remember the following items to complete your application:

    Online application form

    3 letters of support

    Personal statement

    Written paper

The scholarship recipient will be announced by September 15, 2008.

The award will be presented to the recipient at the International Child and Adolescent Conference to be held on November 6-8, 2008 in Minneapolis, MN. The recipient will receive an award of not less than $500 or more than $2,000, an expense-paid trip to the conference (not to exceed $1,000) along with an opportunity to be a presenter at the conference.