2018 Nancy J. Bloch Leadership & Advocacy Scholarship Application

2018 Nancy J. Bloch Leadership & Advocacy Scholarship Application

Deadline: Friday, January 19, 2018
Name*

First NameLast Name
I am deaf or hard of hearing*
Thank you for your interest! This opportunity is geared to applicants who are deaf or hard of hearing. However, if you are still interested in an unpaid internship with the NAD Law and Advocacy Center, please let us know!

We wish you the best in your endeavors.
Permanant Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
College or University*
College or University Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Proof of status as a current student, including academic and financial standing*

Upload a File

Cancelof
Official transcript listing academic courses and grades awarded*

Upload a File

Cancelof
Expected Year of Graduation*
Degree*
Field of Study*
Contact person at educational institution (ie., internship or employment coordinator)*

First NameLast Name
Anticipated Start Date of Internship*

MonthDayYear
Anticipated End Date of Internship*

MonthDayYear
Resume (detailing employment history, internships, co-op experience, etc.)*

Upload a File
.pdf preferred Cancelof
Cover letter and Rationale*

Upload a File
.pdf preferred Cancelof
Description of community activities, especially those pertaining to advocacy and leadership within the deaf and hard of hearing community*
Reference #1*

First NameLast Name
Reference #1's E-mail*
Reference #2*

First NameLast Name
Reference #2's E-mail*
Reference #3*

First NameLast Name
Reference #3's E-mail*
EducationEarly interventionHealth care and mental healthEmployment/vocational rehabilitationSign language as a human rightTechnology/telecommunicationsTransportation/travelOther
Should be Empty: