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 15
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Email *
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
Date *
Applicants Name *
Full Mailing Address *
Phone (year-round) *
University, Major, Minor, year status *
Date of APE (anticipated)Authorization *
Education Information (Universities, Degrees/Majors, credentials, authorizations), dates attended. *
Professional Affiliations and dates of membership *
Description of professional activities and conferences and dates attended. *
Extracurricular activities and offices held or leadership roles (include dates): *
Work experience. (Start with the most recent and indicate paid or volunteer): *
Work or volunteer experience with individuals with disabilities (include dates): *
Scholarship, awards, honors (include dates): *
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). *
List the names, titles, email address, phone number of 3 authors of letters of recommendation. Submit the 3 letters of recommendation  on letterhead to . Letters of recommendation should acknowledge the following criteria: responsibility, enthusiasm, professional attitude, leadership activities, experience and desire to work with individuals with disabilities. *
University Adapted Physical Education Coordinator must submit the following information to

This will verify that__________________________________________________________________
____ ____ 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
Telephone: (w)____________________________
E-mail: __________________________________
University Adapted Physical Education Coordinator Name, university, email address, phone number *
Form completed by name, email address, phone *
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