Wellness Grant Application

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Deadline for application is

Name *

Student Number *

Email *

Are you a full time student at UC Davis? *

Yes

Are you a first generation student?

Yes

Clear selection

Do you participate in Native events on campus? *

Yes

Name and Relation to Family Member(s) Attending (example: Name, Mother) *

Will all participants have the capacity to attend the full duration of the program? *

Yes

Please provide a statement regarding how you may benefit from a family visit *

Dietary Restrictions *

Accessibility Needs *

Transportation *

Flying

Driving

Train

If flying into Davis, what airport will you be flying into? *

I understand that a follow up interview may be required as part of the application process *

Yes

I understand that participating parties will have to provide their own transportation from home to the airport, and from the airport to home *

Yes

I understand that any time I take off of work to attend this program is not reimbursable by UC Davis *

Yes

I understand that children under the age of 12 are not eligible to bring along to this program *

Yes

I understand that no drugs or alcohol are allowed while participating in this program *

Yes

I understand that smoking and vaping are not allowed on the UC Davis campus or in the provided hotel room *

Yes

I understand that all participating parties must attend all programming and events (classes, workshops, etc), as well as attend them on time. *

Yes

I understand that the UC Davis campus is large and driving to campus buildings is not always possible. Visits will likely include a fair amount of walking so comfortable shoes are strongly advised. UC Davis will provide accessibility accommodations if needed. *

Yes

I understand that while attending classes, all participating parties must abide by classroom etiquette *

Yes

I understand that participating students must meet with CAN Counselor once within four weeks after program participation *

Yes

I understand that not following through with the requirements specified in this contract will result in having to reimburse the program for travel and hotel fees *

Yes

Required

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