APPLICATION

2010 Diversity Project 2000 and Beyond (DP2kB)

San Diego, California, August 10 – 13, 2010

DEADLINE June30, 2010

Part I – To Be Completed By Applicant

Regional Institutional Location

Please indicate (check one) the region where the community college you are attending is located.

Eastern / CT DC DE MA MDME NH NJ NY PA RI VT
Midwestern / IAIL IN KS MI MN MO ND NE OH SD WI
Southeastern / AL FL GA KY MS NC PR SC TN VA VI WV
Southwestern / AR LA NM OK TX
Western/Rocky Mountain / AK AZ CA CO HI ID MT NV OR WAWY
Name
Ethnic Identity: Check All That Apply
AfricanAmerican/Black / American Indian/Alaska Native / Asian American/Asian/
Pacific Islander / Hispanic/Latino(a) / European American/Caucasian
Current Address / Street Address
City , State, Zip
PermanentAddress / Street Address
City, State, Zip
Home Phone / Mobile Phone / Email
Community College Name and Address
Are you a U.S.citizen or permanent resident? / Yes / No
Do you plan to earn a BA or BS degree in psychology or a related field? / Yes / No
When do you plan to transfer to a 4-year institution?

All student participants will be provided with APA Convention registration, a one-year APA student membership, and will receive a per diem to cover meals not provided by the Summer Institute. On both workshop days, breakfast and lunch will be provided.

Will you commit to attending the 2010 DP2kB Summer Institute if you are offered the opportunity? A commitment to attend the Summer Institute means the following:

• Arrive at a location to be announced in San Diego, 9:30 AM mornings of August 10 –13, 2010.

• Participate in all program activities from 9:30 AM to 5:30 PM during the 4-day Summer Institute.

• Participate in the Closing Reception at 6 PM or 7 PM on August 13, 2010.

If you answer "yes", then you must do all of the above and be available all day August 10–13, 2010, to participate in the program.

Yes / No

Application for Student Participants

2010 Diversity Project 2000 and Beyond (DP2kB)

San Diego, California, August 10 – 13, 2010

PART II – Supporting Documentation

Email a copy of your transcript, a list of awards and honors received, and a one-page resume.

PART III -To Be Completed By A Psychology Professor

Name
Title and Office Hours
Address
Telephone / Email

Please sign if you recommend this applicant as a candidate for the 2010 DP2kB Summer Institute.

Signature / Date

Application Submission Procedure

Email your application to Robin Musselman, will receive a confirmation of your application within 72 hours of receipt.

Save a copy of this application, complete the application and email it to Robin Musselman, sure to email the application and supporting documents by the due date. You will receive a confirmation of your email within 72 hours of receipt.

Contact Information:

Sandy Ladd, MS

CEO, Diversity Project 2000 and Beyond (DP2kB)

Graduate Student (Med, PhD)

Behavioral Neuroscience Program

Boston University School of Medicine

(email)

(alternate email)

Funding Contingency:

Applicants should be aware that program implementation for 2010, as in past years, is contingent upon receipt of funding from the American Psychological Association’s Office of Ethnic Minority Affairs, Education Directorate, and Minority Fellowship Program; and the National Institute on Drug Abuse of the National Institutes of Health.

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