Chavez LAB RA Application

Community-Based Participatory Research (CBPR)

Research Assistant Application
Academic Year *
Term:*
Biographical Information:
Name*

First NameLast Name
Phone Number*
E-mail*
example@example.com
Coyote ID*
Major*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Class Level*
Major GPA*
Cumulative GPA*
Previous Psychology courses and grades received (including PSYC 210 and 311):*
Personal Statement (please submit your typed responses to the following prompts on a separate page, preferably a PDF. Please make sure you answer all prompts):
- Describe the experience that you have had in research-related projects.
- Also describe experiences with community-based organizations or other helping groups.
- What are your unique talents that you could contribute to research/service group working with youth, families, and community-based organizations?
Personal Statement Upload:*

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Eduational Objectives (please provide your typed responses to the following prompts on a separate page, preferably a PDF. Please make sure that you answer all prompts):
- What are your plans/goals for the future?
- How would your participation with this group help you achieve these goals?
- Why are you interested in working in the particular setting you want to work in?
- What are your particular research interests related to this area?
Educational Objectives Upload:*

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Please rank order which organization you would like to work with:*

	Rank
Boys and Girls Club of Valencia Vista
Rainbow Pride Youth Alliance
Magdalena's Daughters

Availability:

In case you are selected to contribute to this group, what is the approximate amount of hours you will be willing to spend per week and your hours of availability? Be aware that afternoon availability is particularly desirable. (Keep in mind that even though we are conscious of schedule changes and will accommodate shifting quarterly schedules, we are looking for your commitmemnt to last for a full year).

Please remember all settings are open in the afternoon hours.*

Total hours per week *
Do you speak Spanish?*
Academic/Professional References

Please provide at least two individuals who will be contacted by e-mail or phone and select the preferred method of communication for each:
Name*
Phone Number*
Please enter a valid phone number.
E-mail*
example@example.com
Preferred method of communication*
Name*
Phone Number*
Please enter a valid phone number.
E-mail*
example@example.com
Preferred method of communication*
Name
Phone Number
Please enter a valid phone number.
E-mail
example@example.com
Preferred method of communication
Student Signature*

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Date*

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Date
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Community-Based Participatory Research (CBPR)