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* These questions are optional. We ask that you answer them so that we can ensure a diverse group of awardees.
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Type of Disability:
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Gender:
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Race or Ethnicity:
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Age:
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In order for us to continue to improve our outreach and dissemination, please let us know how you heard about this awards program/and or received the application.
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Please tell us how you heard about this Program.
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Essay Questions
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What do you see as the most significant national issue facing the cross disability community and what steps would you take to address it? (350 words)
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Based on your work to date, what are your priorities for your work over the next three years, and how would you work with AAPD to adhere to those goals. (300 words)
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Describe how a supportive colleague/mentor has enabled you to achieve your goals, and why having them as a resource was helpful to your cause. (300 words)
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You are selected to have a (3-5 min)/short documentary film about you and your work featured at the 2012 Leadership Gala. What would you pick as the theme of your video, and how would that theme take your work from the local to national level? (600 words)
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Two (2) Letters of Support
Applicants must also attach two letters of support.
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One (1) letter from a professional reference who can attest to the impact of your work on the local community, and the importance of your work for the broader national disability community; and,
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One (1) letter from a mentor or supportive colleague who is committed to working closely with you during your year as a Hearne Award Laureate, and who addresses your qualifications for the award, your commitment to pursuing your personal leadership goals, and the specific ways in which he/she will mentor you in achieving those goals.
Your application is not considered completed until BOTH letters have been received by AAPD. Thus we STRONGLY urge attaching your two (2) letters directly to your application in Microsoft Word format and submitting them electronically to awards@aapd.com. Please ensure that BOTH references provide a way for AAPD to contact them.
Note: We are not able to consider supplementary materials in excess of these application requirements.
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Support Letter 1:
Support Letter 2:
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ALTERNATE FORMATS:
Please contact AAPD, by phone 1-800-840-8844 (V/TTY) or 202-457-0046 (V/TTY), or 1-800-840-8844 (voice/TTY), or by e-mail at awards@aapd.com, to request alternate formats of this application.
You may also mail your application to:
2011 AAPD Paul G. Hearne Leadership Awards
AAPD
1629 K Street NW, Suite 950
Washington, DC 20006
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