Adapted Physical Education Student Scholarship
California State Council on Adapted Physical Education

$1000 Scholarship to be presented at the National Adapted Physical Education Conference

Due Date April 15th.

Qualifications:
Specialize in the field of Adapted Physical Education
Pursuing adapted physical education authorization or graduate work in APE
CAHPERD member
Attending a California college/university
Criteria for Selection:
Experience/interest in working with individuals with disabilities
Scholastic proficiency
Leadership ability
Personal qualities
School, community and professional activities
Applicants Name
Your answer
Full Mailing Address
Your answer
E-Mail Address (year-round)
Your answer
Phone (year-round)
Your answer
University, Major, Minor, year status
Your answer
Date of APE (anticipated)Authorization
Your answer
Education Information (Universities, Degrees/Majors, credentials, authorizations), dates attended.
Your answer
Professional Affiliations and dates of membership
Your answer
Description of professional activities and conferences and dates attended.
Your answer
Extracurricular activities and offices held or leadership roles (include dates):
Your answer
Work experience. (Start with the most recent and indicate paid or volunteer):
Your answer
Work or volunteer experience with individuals with disabilities (include dates):
Your answer
Scholarship, awards, honors (include dates):
Your answer
Please supply any additional information you believe is pertinent to this application and a statement of your professional goals and philosophy of physical education for individuals with disabilities: (not to exceed 300 words).
Your answer
List the names, titles, email address, phone number of 3 authors of letters of recommendation. Submit the 3 letters of recommendation on letterhead to califstatecouncilape@gmail.com . Letters of recommendation should acknowledge the following criteria: responsibility, enthusiasm, professional attitude, leadership activities, experience and desire to work with individuals with disabilities.
Your answer
SCHOLASTIC VERIFICATION
University Adapted Physical Education Coordinator must submit the following information to califstatecouncilape@gmail.com:

This will verify that__________________________________________________________________
NO YES
____ ____ 1. has completed ______ units of under graduate college work with an overall GPA of ________
____ ____ 2. has a specialization in Adapted Physical Education.
____ ____ 3. has completed ___________ units of graduate college work with an overall GPA of _________
____ ____ 4. will be doing his/her last semester of student teaching in the area of Adapted Physical Education
Starting date: __________________________
Ending date: ___________________________
Signature: _______________________________________________________________________
University Adapted Physical Education Program Coordinator
_______________________________________________________________________________
College/University
Telephone: (w)____________________________
E-mail: __________________________________

University Adapted Physical Education Coordinator Name, university, email address, phone number
Your answer
Form completed by name, email address, phone
Your answer
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