LEND Application | Stony Brook LEND Center

Primary Contact Information

Full Legal Name

Title

First

Middle

Last

Suffix

Degree

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Phone

Personal Email

What is the best way to contact you?

How did you hear about this program?

Please pick the best answer(s) below describing your relationship with disabilities (click all that apply)

Person with a disability

Person with a special health care need

Parent of a person with a disability

Parent of a person with a special health care need

Family member of a person with a disability

Family member of a person with a special health care need

None

Unrecorded

Demographic Information

US Citizen

Please list all languages you are fluent in.

What, if any, accommodations do you need to help you actively participate in educational opportunities offered online or in-person? (For example: large print, Braille, sign language interpreter)

Have you ever been convicted of a felony or a non-traffic related misdemeanor?

Date of Birth

Education/Current Degree Program

What is the Highest Degree program you have completed?

What is the institution you have received your Highest Degree from?

Are you currently enrolled in an academic program?

If Yes, please state the institution and program you are enrolled in.

Please list credentials or licenses you currently maintain.

Choose the LEND track to which you wish to apply

Which LEND trainee track are you applying for?

For the next question, please select a discipline where you have a degree or are pursuing a degree in that discipline only. To select Family you must have a family member with a disability. To select self-advocate you must be a person with a disability. If you have the ability to apply to more than one discipline, select the discipline where you feel like you can contribute the most to the program.

Please select a discipline where you have a degree or are pursuing a degree in that discipline.

To select Family you must have a family member with a disability, to select self-advocate you must be a person with a disability.

If you have the ability to apply in more than one discipline, select the discipline where you feel like you can contribute the most to the program.

Is there a specific age group or type of disability in which you are particularly interested in learning about?

Please describe your professional and/or personal experiences with individuals with ASD/DD.

Please describe your career goals, and how the SBU LEND training will assist you in achieving these goals

Please discuss how your area of study/work and/or lived experience addresses or supports a commitment to improving the health and well-being of the ASD/DD population.

Please describe your leadership potential and experience.

Why are you interested in participating in the Stony Brook LEND Interdisciplinary Traineeship?

Reference Information

Reference Name

Reference Email

Reference Agency or Institution

Reference Job Title (of the Reference)

Please upload recommendation letter from your reference.

Upload requirements

Resume/CV

Please upload your most current Resume/CV.
Upload requirements

Please confirm that you are able to commit to 300 hours or more over the course of the Stony Brook LEND traineeship (August - May).

Would you be interested in participating as a LTT if the full stipend is not available?