KOVAR INSTITUTE APPLICATION Forma

KOVAR INSTITUTE APPLICATION FORM

NAME______A SUMMER EDUCATIONAL AND ENRICHMENT SCHOOL ADDRESS______OPPORTUNITY

Ph.#______EMAIL ADDRESS ______

PERMANENT ADDRESS______

Ph.#______EMAIL ADDRESS ______

WHICH ADDRESS WOULD YOU LIKE TO BE CONTACTED? SCHOOL  PERMANENT 

COLLEGE/UNIVERSITY______

ACADEMIC PROGRAM/MAJOR______

INDICATE YEAR OF STUDY: FRESHMAN  SOPHOMORE  JUNIOR  SENIOR  GRAD YR1  GRAD YR2 

FULL-TIME STUDENT  PART-TIME STUDENT  HOW DID YOU HEAR ABOUT KOVAR? ______The 2011 CURRENT EMPLOYER, IF ANY ______KOVAR Summer Institute

PLEASE ATTACH THE FOLLOWING TO THE APPLICATION FORM: On . A BRIEF STATEMENT OF WHAT YOU HOPE TO GAIN FROM YOUR EXPERIENCE AT Individuals with THE KOVAR INSTITUTE.

. EXCERPT CONTAINING FUTURE CAREER ASPIRATIONS. Intellectual and

. SUMMARY OF ACADEMICS & RELATED WORK EXPERIENCE. Developmental Disabilities

. LETTER OF RECOMMENDATION FROM A FACULTY MEMBER.

MAIL OR FAX TO: Southside Virginia Training Center P.O. Box 4030 Petersburg, VA 23803 June 6th – June 25th Attn: Angela Harvell, Project Coordinator (Bldg. 40)

Phone # (804) 524-7696 Fax # (804) 524-4633 OR E-MAIL TO: [email protected]

APPLICATION DEADLINE BY APRIL 18, 2011 STUDENTS WILL BE NOTIFIED OF THEIR SELECTION BY May 2, 2011 PURPOSE ADMISSION REQUIREMENTS A SUMMER EDUCATIONAL AND To expose future practitioners in the allied health and human The Institute is open to students currently ENRICHMENT OPPORTUNITY services professions to individuals with intellectual and enrolled in professional programs in developmental disabilities and associated medical conditions. any Allied Health or Human Service profession such as Medicine, Nursing, Dentistry, Social Work, Recreation To familiarize and sensitize future practitioners so that they will be Therapy, Music, Psychology, Occupational able to support individuals with intellectual and developmental and Physical Therapy, Audiology, Speech THE 2011 SUMMER disabilities. Pathology, Visual Impairment, INSTITUTE ON Rehabilitation Engineering and Special To expand the knowledge of students in the field of intellectual Education. INDIVIDUALS WITH and developmental disabilities and the provision of needed INTELLECTUAL supports. AND INVITED FACULTY DEVELOPMENT To provide opportunities for students to collaborate as an AL interdisciplinary team during this experience and become familiar DISABILITIES with person-centered planning practices.  Joann Bodurtha, M.D. M.P.H. Associate Professor, Dept. of Human Genetics, VCU INSTRUCTION  Michael Gillette, Ph.D., Pres. The KOVAR Summer Institute is a three-week, 30-hour per week Bioethical Services of Va., Inc. (9am-3pm) fellowship program. Participants will devote the majority of their time to the development of clinical skills through  Other college and university Faculty; participating experts in academic lectures, case presentations, interdisciplinary team the field of intellectual and meetings, and other clinical learning activities. The knowledge developmental disabilities; base to support these activities is provided through regularly consumers and family members. scheduled seminars. SEMINAR TOPICS, ACTIVITIES

Respecting Differences Sponsors Ethics, Values and Personal Responsibility Person Centered Planning Knights of Virginia Assisting Medical and Neurological Assessment Psychiatric Overview Citizens with Intellectual Autism Disabilities Dual Diagnosis Positive Behavior Supports Department of Behavioral Physical Therapy Occupational Therapy Health and Developmental Communication Skills Services Community Integration Supported Employment Location Family Perspectives

STIPEND Southside Virginia Campus Students that are accepted and fully participate (5 days a week) will Petersburg, Virginia be awarded a stipend of $1200.00. Stipend may be subject to tax.

Housing will not be provided.