American Indians Into Psychology

Applications for the Summer Enrichment Program are due May 1 of each year.

STUDENT NAME STUDENT NAME First Last
MAILING ADDRESS MAILING ADDRESS
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
TELEPHONE (HOME) TELEPHONE (HOME) - ### - ### ####
TELEPHONE (BUSINESS) TELEPHONE (BUSINESS) - ### - ### ####
TRIBAL AFFILIATION
ENROLLMENT NUMBER
NAME OF COLLEGE/UNIVERSITY
YEAR IN SCHOOL
ANTICIPATED DATE OF GRADUATION
GPA
ACT/SAT SCORES
Check your interest area(s):

Check your interest area(s): CLINICAL PSYCHOLOGY COUNSELING PSYCHOLOGY SCHOOL PSYCHOLOGY
In addition, please provide:
a) Two letters of recommendation, preferably one from
a university faculty member and one from your
tribal community.
b) Statement of goals( one page maximum)
for pursuing a career in psychology.
c) Transcripts
d) A copy of your CDIB or Tribal Enrollment Card