xxold- Independent SLDP ApplicationStudent Leadership Development Program Application Applicant InformationAPPLICANT:* First Last ADDRESS:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country DAYTIME PHONE:*ALTERNATE PHONE:EMAIL:* ALTERNATE EMAIL:Indicate an alternate email where you will be reachable March-June 2022 if not at the above email address. CITIZENSHIP STATUS:*Indicate your current citizenship status U.S. Citizen Permanent Resident of the U.S. F-1 Student Visa HolderUniversity/Education DetailsUNIVERSITY:*Select OneBaldwin Wallace UniversityBluffton UniversityBowling Green State UniversityCase Western Reserve UniversityCleveland State UniversityCollege of WoosterKent State UniversityMiami UniversityMt. St. Joseph UniversityMt. Vernon Nazarene UniversityOhio State UniversityOhio UniversityUniversity of AkronUniversity of CincinnatiUniversity of ToledoMAJOR OF STUDY:*Indicate the educational program/major you are currently studying/pursuing. Speech-Language Pathology Audiology BothACADEMIC LEVEL:*Indicate the level of education you are currently enrolled in. Undergraduate Graduate DoctoralCURRENT GRADE POINT AVERAGE (GPA)*EDUCATION HISTORYUniversity NameDegree EarnedSpecialty/Focus AreaYear Completed List your academic history (if any)Employment & AccomplishmentsRESUME & EMPLOYMENT EXPERIENCEInclude Your Resume with Your 3 Most Recent Employment Experiences Listed Within.Max. file size: 50 MB.MAJOR ACCOMPLISHMENTS:*List 3 of your most notable personal, academic or professional accomplishments VOLUNTEERISM:List any volunteer activities you have engaged inRECOGNITIONS/AWARDS:List any (academic, sports, talent, or professional) awards or recognitions you have received:CIVICS/COMMUNITY:List any civic or community activities you participated in planning, hosting, or leading. Be sure to include dates and organization affiliations.Personal Statement:Personal Statement File Upload*Prepare and upload a 1-page written statement answering these questions "Why Are You Applying for This Program, What Do You Hope to Gain From This Experience and What Are Your Post-Graduation Goals"?Max. file size: 256 MB.AcknowledgementsIn the event I am selected as a participant in this OSLHA programming...HiddenFinancial Commitment Consent:*I acknowledge that OSLHA will provide a stipend to cover a portion of my program participation costs and that I am responsible for acquiring the resources to offset all costs beyond that amount. I also understand that expenses up to the stipend maximum can be requested for reimbursement when submitted with reimbursement paperwork and valid receipts before the established reimbursement deadline. I Acknowledge & Agree to the Program TermsParticipation Consent*I acknowledge that participation in this program requires my full attendance through the entire virtual program and may be required to complete short assignments in preparation for participation. I Acknowledge & Agree to the Participation TermsSupporting DocumentationUpload Your Required Letter of SupportFaculty Letter*Upload One Letter of Support From a Faculty Member of Your Major Program of StudyMax. file size: 10 MB.HiddenProgram Director/Chair LetterUpload One Letter of Support From the Program Director or Chair of Your Academic Program.Max. file size: 10 MB.DeadlineSubmit your proposal by our Extended March 31, 2022 Deadline!EmailThis field is for validation purposes and should be left unchanged.Δ
