Connpsych.org
Connecticut Psychological Association Ethnic Diversity Task Force-Ethnic Minority Student Mentoring Scholarship Annual Convention Scholarship Application – 2021 CPA Convention: October 22, 2021Name:________________________________________Date: _____________ Phone: _______________________________E-mail: _____________________________Address:________________________________________________________________ 1. Student Status (please check one): a. Graduate ? University/Professional School: _____________________________________b. Undergraduate ? University/College: ______________________________________________c. High School ? High School: __________________________________________________ 2. Demographics (please check all that apply): ? Native American ? Alaskan Native ? Asian or Pacific Islander ? Black Caribbean ? African American ? Hispanic/Latino/Latina ? European American/Caucasian ? Middle Eastern ? Other (please specify):__________________________________ 3. Have you attended the CPA Convention in the past? ? Yes ? No If so, what year/s? _____________________ 4. Have you ever received an EDTF Scholarship in previous years? ? Yes ? No If yes, what year/s? ____________________ Registration deadline: September 15, 2021Complete this application and send it to CPA by either e-mail: tricia@ or snail mail: CPA office, P.O. Box 915, North Haven, CT 06473 ................
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