1. First Name Surname

2. Native Language  

3. Gender: Female  Male

9. Are you a current member of ISPA? Yes    No

10. Are you a current member of a local or national school psychology organization? Yes  No

11. Name of organization

12. Are you: A School Psychologist? Retired?

a) Practitioner? b) Trainer? Other (Specify)

13. What contributions have you made to School Psychology?

14. Who is nominating you for this scholarship?

15. Why are you applying for financial aid? (explain your financial need)

16. Your goal if financial aid is awarded

17. What specific activities will you perform to reach the goal stated in number 16?

18. Please list the names of the other associations or organizations you have
requested assistance from:

19. Have you received financial aid from a source other than ISPA?

Yes    No

If yes, was financial aid awarded? Yes    No  Amount

Name of source

20. Have you received financial assistance from ISPA's Cal Catterall Fund previously?

Yes    No

 If Yes, when?

21. If employed, please print the names and addresses of two professional references (not relatives)

                            A                                                         B

22. If a student, please print the name, address and position of your major professor or advisor

23. Financial aid requested: The following amounts will be preset by LOC:

Registration:   Yes    No

Accommodations (dormitory only), July 8-13:  Yes    No    

Extra Meal Allowance:   Yes    No

Other: If requesting additional funds please indicate the amount and justify

____________________________________________________________________________________

24. By submitting this request, I declare that I have not misrepresented or falsified any of the above information. Further, I understand that if the terms of the financial aid award are violated, I must return to the International School Psychology Association the full amount of the award which was granted.

Name:     Date: