UW LEND Application

Required Documents for Your Application:

Your responses to demographic information (see below)
Personal Statement (PDF): Please complete this form
Copy of resume or CV
Two references (your references complete this Recommendation Form)

First Name*:	Last Name*:
Date of Birth*:	Place of Birth*:
Your Email*:	Alternate Email:
Mobile Phone*:
Mailing Address
Address Line 1*:	Address Line 2:
City and State/Province*:	Zip/Postal Code*:
*Preferred UW LEND Trainee Discipline:**

*Gender:**	*Preferred pronoun:**

To select multiple, please press and hold the control-key (PC) or command-key (Mac)
*Ethnicity/Race:**	*Languages Spoken:**
*Are You a US Citizen:YesNo Note:** UW LEND can only offer training stipends to individuals who are US Citizens; we welcome all applicants; status of citizenship only affects eligibility for stipend.

Academic Information
Please complete if you are a current/former University of Washington student/employee.
UW Student Number:
UW Employee ID:
UW NetID:
*Highest Degree Attained:**
Degree Sought (if applicable):

How would you describe your relationship to individuals with a developmental disability? To select multiple, hold control-key (PC) or command-key (Mac)

If you selected 'Other' above, please enter your information in the text box below:

Please upload your Personal Statement, Resume or CV, and two References.
Personal Statement* (Accepted file types: pdf, doc, docx, Max. file size: 2 MB)
Resume or CV* (Accepted file types: pdf, doc, docx, Max. file size: 2 MB)
Personal Reference #1 (Accepted file types: pdf, doc, docx, Max. file size: 2 MB)
Personal Reference #2 (Accepted file types: pdf, doc, docx, Max. file size: 2 MB)

The UW LEND mission is to build a future healthcare workforce of clinicians, educators, and family and self-advocate leaders who represent the communities we serve. UW LEND is committed to bringing together learners from a variety of backgrounds and lived experiences. The information you provide in your application helps to ensure that we are accountable to the goals of our mission.

All fields with (*) are required

Mailing Address

Demographic Information

Please select all that apply

Additional Information

All fields with (*) are required

Mailing Address

Demographic Information

Please select all that apply

Additional Information

Required Documents for Your Application:

Mailing Address

To select multiple, please press and hold the control-key (PC) or command-key (Mac)

Academic Information

To select multiple, hold control-key (PC) or command-key (Mac)

UW LEND Application

For assistance completing the application materials, please contact nan Ringera, Administrative Assistant. We want to assure your success with this process - please do not hesitate to contact us for help.
All fields with (*) are required
First Name*:	Last Name*:
Date of Birth*:	Place of Birth*:
Preferred Email*:	Other Email:
Mobile Phone*:
Mailing Address
Address Line 1*:	Address Line 2:
City*:	State/Province*:
Zip/Postal Code*:
*Preferred Primary LEND Trainee Discipline:**

Demographic Information Why are we collecting this information?: The UW LEND mission is to build a future healthcare workforce of clinicians, educators, and family and self-advocate leaders who represent the communities we serve. UW LEND is committed to bringing together learners from a variety of backgrounds and lived experiences. The information you provide in your application helps to ensure that we are accountable to the goals of our mission.
*Gender:**	*Pronoun:**
*Ethnicity/Race:** Please select all that apply American Indian/Alaskan NativeAsian – regional ancestry not specifiedCentral AsianEastern AsianSoutheastern AsianSouth AsianBlack – regional ancestry not specifiedBlack – African AmericanBlack – African CanadianBlack - East AfricanBlack – Latin AmericanBlack – West AfricanHispanic – Latina (a)(x) Mexico and Central AmericanHispanic – Latina (a)(x) CaribbeanHispanic – Latina (a)(x) South AmericanHispanic – Latina (a)(x) Spanish originHispanic – Latina (a)(x regional ancestry not specifiedMiddle EasternNative Hawaiian/Pacific IslanderNorth AfricanWhiteOtherPrefer not to say
*Languages Used (Fluent):**
*Are You a US Citizen:YesNo Note:** UW LEND can only offer training stipends to individuals who are US Citizens; we welcome all applicants; status of citizenship only affects eligibility for stipend.

Additional Information How would you describe your relationship to individuals with a developmental disability? (Check all that apply)
I have a developmental disabilityI have a special health care needI consider myself neurodiverseParent of a person with a developmental disabilityParent of a person with a special health care need	Family member of a person with a developmental disabilityFamily member of a person with a special health care needDoes not applyPrefer not to answerOther

Please upload your Personal Statement, Resume or CV, and two References.
Personal Statement* (Accepted file types: pdf, doc, docx, Max. file size: 2 MB)
Resume or CV* (Accepted file types: pdf, doc, docx, Max. file size: 2 MB)
Personal Reference #1 (Accepted file types: pdf, doc, docx, Max. file size: 2 MB)
Personal Reference #2 (Accepted file types: pdf, doc, docx, Max. file size: 2 MB)