Fillable Cmsd-ape-tier-grant-f19-application APE Program ~ TRACK Grant

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Cmsd-ape-tier-grant-f19-application APE Program ~ TRACK Grant

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Dear CMSD Student,
Thank you for your interest in the Communication Sciences and
Disorders (CMSD) grant program at CSU, Chico. Students
pursuing a Master’s degree in CMSD may apply for funding
under the federal grant Training and Interdisciplinary Education
and Research (TIER).
The grant program is funded from the U.S. Department of
Education, Office of Special Education Programs. In accordance
with this project’s requirements, you will be required to
perform work related to Communication Sciences and
Disorders upon completion of the program.
Enclosed you will find the following items:
1. Application for TIER Grant for Fall 2019.
2. Student Objectives and Responsibilities for the CMSD
TIER Grant.
Please submit the Application for the CMSD TIER Grant with the
appropriate documentation as soon as possible. Please contact
me if you have questions or to determine specific course
requirements at (530) 898-4286.
Sincerely,
Jessika Lawrence, Ph.D.
Project Co-Director
Communication Sciences and
Disorders Program
California State University, Chico
Dr. Jessika Lawrence,
Project Co-Director
E-mail: rlytle@csuchico.edu
Phone: 530-898-4298
CMSD Program ~ TIER Grant
The CSU, Chico Communication Sciences and Disorders Program is pleased to announce
the availability of grant funding to help students in the area of Speech-language pathology
education. Students may apply for funding for the academic year program under the
federal grant Training and Interdisciplinary Education and Research (TIER). The
TIER grant is a federal grant to train students to work with children with disabilities in the
field of Speech-language pathology.
Academic year grant recipients receive funding for stipend awards, books, and travel to
conferences. If selected as a participant in the academic year grant program, you may
receive a maximum of $20,300 funding over a maximum of four semesters.
To apply for the Fall 2019 CMSD TIER Grant, submit a complete application package by
May 1st.
Checklist for a complete Fall 2019 application
_____ Form A: Application for CMSD TIER Grant for Fall 2019
_____ Form B: Applicant Data Survey
_____ A typed letter of application (2 pages maximum) which addresses your career goals,
including your experience working with individuals with disabilities.
_____ One official transcript of all college work
_____ Information for three references (Name, Job Title, Phone, Email Address)
_____ Two letters of recommendation, from two of the three references above
Deliver or mail complete application materials to:
Jessika Lawrence, Ph.D. Phone: (530) 898-4286
CMSD Program, CMAS Department Email: jlawrence14@csuchico.edu
CSU, Chico
Chico, CA 95929-0350
CMSD TIER Grant
Please keep this page for your
records.
California State University, Chico
Chico, CA 95929-0350
Communication Sciences and Disorders Program E-mail: jlawrence14@csuchico.edu
Dr. Jessika Lawrence, Project Co-Director Phone: 530-898-4286
Application for CMSD TIER Grant
Fall 2019
Name _______________________________________________________________________________________________________________
Street Address _____________________________________________________________________________________________________
City ____________________________________________________ State _________ Zip Code _______________________
Home Phone ________________________ Work Phone _________________________ Cell Phone ________________________
SSN ________________________________ Date of Birth _______________________________
Email address ______________________________________________________________________________________________________
Employment
Place of Employment ______________________________________________________________________________________________
Employment Address _____________________________________________________________________________________________
Position _______________________________________________ Supervisor _______________________________________________
Course of study at CSU, Chico
Master’s degree in CMSD
Enrollment: FT or PT Expected completion date of program: __________________________
Do you currently have a credential to teach in California? Yes No
If yes, name of credential(s): ____________________________________________________________
Are you currently working as a teacher? Yes No
If yes, please describe): ________________________________________________________________
Are you bilingual? Yes No If so, which language(s) _____________________________________________
Will you apply for financial aid funds for Fall 2019 at CSU, Chico? Yes No
Education
College/University Course of Study Completed Units GPA Degree Earned
________________________________________________
________________________________________________
________________________________________________
Form
A
Applicant Data Survey
We consider all applicants without regard to race, color, religion, creed, gender, national origin,
age, mental or physical disability, marital or veteran status, sexual orientation, or any other
legally protected status. Please note the following exception: United States government
guidelines require all recipients of funds from our current federal grant be U.S. Citizens.
This survey is not a part of your official application for the grant program and will not be used
in any decision regarding the award. The purpose of the Applicant Data Survey is to comply
with government record-keeping, reporting, and other legal requirements. Completing this
survey is strictly voluntary.
Your cooperation is appreciated.
Position(s) applied for Grant funding in CMSD TIER Grant Date
Name Telephone
Last First Middle
Address
Number, Street, Apt City State Zip Code
Referral Source(s)
Advertisement in (name) Conference
Referred by (name) Other
Web site
Equal Employment Opportunity Identification Groups
Date of Birth: Please check one: Male Female
(Month/Day/Year)
Please check one: Caucasian African Hispanic Asian/Pacific Islander
American Indian/Alaskan Native Other
Please check if any of the following are applicable:
Vietnam Era Veteran Veteran with a Disability
Individual with a disability Re-entry student
I understand that I’m providing this information voluntarily and it will be kept strictly confidential.
________________________________________________________________________ _______________________________
Signature Date
Form
B
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California State University, Chico
Chico, CA 95929-0330
Communication Sciences and Disorders Program E-mail: jlawrence14@csuchico.edu
Dr. Jessika Lawrence, Project Co-Director Phone: 530-898-4286
CMSD TIER TRACK Grant
Academic Year Program
Training and Interdisciplinary Education and Research
Student Objectives
1. Complete a master’s degree in Communication Sciences and Disorders.
2. Participate in interdisciplinary field experience in addition to other services which will
further the availability of quality speech-language pathology programs for children with
disabilities.
3. Develop the necessary skills to become an expert clinician of multicultural students with
disabilities, with a particular focus on students with high intensity needs.
4. Address the needs of children with disabilities, including early intervention, school-aged
population, and transition programs.
5. Facilitate the development of successful and mutually beneficial partnerships with
children’s families to support effective service delivery.
Student Responsibilities
1. Notify Dr. Jessika Lawrence, program co-director of the TIER Grant, of all changes in
address and employment status until the service obligation has been satisfied.
jlawrence14@csuchico.edu
2. Students are expected to participate in 10-15 hours per week in field experience
placements per semester. Contracts for field experience hours are to be completed at the
beginning of each semester in collaboration with the program advisor.
3. Maintain satisfactory progress toward the credential or degree.
GPA requirements:
Masters – GPA 3.0 in each graduate course.
4. Attend all mandatory grant recipient meetings, typically 1-2 per semester.
5. All grant-funded students are expected to attend all classes, demonstrate model academic
behavior, be independent thinkers and learners, and be punctual and professional in all
interactions with parents, children, peers, and community programs.
6. Take and pass the PRAXIS exam during your final semester of funding. View complete
details at https://www.ets.org/praxis/
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Cmsd-ape-tier-grant-f19-application APE Program TRACK Grant

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Completed 15 March 2020

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