National Conference Scholarship Opportunity!

The West Virginia Statewide Independent Living Council is offering scholarships for young adults with disabilities to attend the National Council on Independent Living (NCIL) Annual Conference in Washington, DC July 26-30, 2015 and we want you to apply!

Young adults with disabilities (ANY disability) ages 18 to 26 are eligible to apply for a scholarship to cover conference registration, travel, lodging, and meals for this premier national conference.  

NCIL’s Annual Conference draws individuals of all ages and disabilities from all 50 states and the territories. In recent years, the NCIL conference has hosted nearly 1,000 individuals, including grassroots advocates, CIL and SILC leadership, and representatives from other major organizations that work for justice and equity for people with disabilities. In 2015, over 1,000 community members, leaders, and advocates are expected to unite in our nation’s capital to celebrate the 25th Anniversary of the ADA.  NCIL will honor the past and catalyze the future as we rise up to learn from young advocates that have grown up in the 25 years since that momentous legislative victory.
The 2015 NCIL Annual Conference will feature the following workshop tracks:
•	SILC Track: Workshops covering best practices and innovation in operations and programs of Statewide Independent Living Councils; 
•	ILA Track: Workshops for CILs or SILCs related to the IL Program’s transition to the Independent Living Administration at the US Department of HHS; 
•	Youth Track: Workshops related to youth leadership, outreach, and movement building; 
•	Orientation Track: Workshops aimed at orienting young advocates and new attendees to NCIL, disability rights advocacy, and federal legislation; 
•	General Track: Workshops for staff, consumers, and other advocates in the Independent Living Movement that do not fit the other four categories.

For more information on NCIL and the Conference visit www.ncil.org 

Instructions for Application
Please follow the instructions in this booklet to complete the scholarship application process.  
Your completed application must be postmarked by April 15, 2015.  
Mail to:  WVSILC, P.O. Box 625, Institute, WV 25112-0625 
Or Fax to:  304-766-4721.
•	Please type or print with black ink. 
•	Please make certain your application packet is complete. *All questions must be answered and required attachments provided.  Please submit application and all attachments under one cover if possible.  Incomplete packets will not be considered.  

*For assistance and accommodations to complete this application or to receive this application packet in electronic format call 1-855-855-9743.  
		
Required Items Checklist
Check to make sure your application includes all of the following:
1.	Completed application form	
2.	Two recommendations
3.	Resume´
4.	Essay (response to five questions)

NCIL Conference Location
The Grand Hyatt at 1000 H Street, Washington D.C. is the official NCIL Conference hotel and the site of all events.  Delegate room reservations will be made at the Grand Hyatt by West Virginia Statewide Independent Living Council staff based on the needs you list on this application form.  

NCIL Conference Accessibility
The WV Statewide Independent Living Council is committed to providing the highest degree of accessibility possible when conducting the NCIL Conference and all other activities.

Accessible Formats
All materials distributed during the NCIL Conference by staff, presenters, or delegates must be available in ALL accessible formats including large print, computer diskette, and Braille.  Please indicate your need for accessible formats for your personal use on the application form.  

Environmental Accessibility
It is essential that we maintain a smoke-free, environmentally sensitive environment for everyone at the NCIL Conference.  For the safety and comfort of those with chemical and environmental illnesses and sensitivities:

•	Please refrain from using any perfumed grooming products such as scented 
          soaps, scented deodorants, scented hair products, perfumes, and colognes
•	Ensure that all service animals are freshly bathed and well groomed
•	Smoke only in designated smoking areas

2015 Annual Conference Agenda
Sunday, July 26
•	Registration Open: 10:00 a.m. – 5:00 p.m.
•	Pre-Conference Session(s): 1:00 p.m. – 4:00 p.m.
•	Orientation Session: 5:00 p.m. – 6:00 p.m.
Monday, July 27
•	Registration Open: 8:00 a.m. – 5:00 p.m.
•	Opening Plenary: 9:00 a.m. – 10:00 a.m.
•	Legislative & Advocacy Update: 10:15 a.m. – 11:30 a.m.
•	Preparing for the Day on the Hill: 11:30 a.m. – 11:45 a.m.
•	Lunch (on your own): 11:45 a.m. – 1:00 p.m.
•	Concurrent Workshops I: 1:00 p.m. – 2:15 p.m.
•	Regional Caucuses (Regions I-V): 2:45 p.m. – 3:45 p.m.
•	Regional Caucuses (Regions VI-X): 4:15 p.m. – 5:15 p.m.
•	ADA 25th Anniversary Celebration: 7:00 p.m. – 11:00 p.m. – President Obama invited
Tuesday, July 28
•	Organize for the March: 9:30 a.m. – 10:00 a.m.
•	March to the US Capitol: 10:00 a.m. – 11:00 a.m.
•	Bag Lunches: 11:00 a.m. – 11:30 a.m.
•	2015 Rally at the US Capitol: 11:30 a.m. – 12:30 p.m.
•	Hill Visits: 1:00 p.m. – 5:00 p.m.
Wednesday, July 29
•	Exhibitor Set-up: 7:00 a.m. – 8:00 a.m.
•	Registration & Exhibits Open: 8:00 a.m. – 5:00 p.m.
•	Concurrent Workshops II: 9:00 a.m. – 10:15 a.m.
•	Exhibit Fair: 10:15 a.m. – 12:00 p.m.
•	Awards Luncheon: 12:00 p.m. – 2:00 p.m.
•	Annual Meeting: 2:30 p.m. – 5:30 p.m.

Thursday, July 30
•	Registration & Exhibits Open: 8:00 a.m. – 5:00 p.m.
•	Concurrent Workshops III: 9:00 a.m. – 10:15 a.m.
•	Concurrent Workshops IV: 10:30 a.m. – 11:45 a.m.
•	Lunch (on your own): 11:45 a.m. – 1:30 p.m.
•	Concurrent Workshops V: 1:30 p.m. – 2:45 p.m.
•	Legislative Debriefing: 3:00 p.m. – 4:30 p.m.
•	Closing Plenary: 4:30 p.m. – 5:15 p.m.
NCIL Conference Scholarship Application Form

Please type or print all information.  Use a separate form for each person applying for the NCIL Conference Scholarship.  

Name:														

Address: 													

City: 					    County: 			  State:  	  Zip Code:		

Phone: (	) 		 - 			

E-mail address: 												

Birth Date:  		 Day 			  Month 			  Year  			

Please check all that apply (This information is requested in order to assure that we include delegates of varied and broad representation)

Gender:           Male		    Female

Race/ethnicity:
African American/Black		Hispanic			Native American
Caucasian/White			Asian/Pacific Islander	  
Other (please specify) 											
    
Please indicate your disability (This information will be kept confidential.  It will be used to ensure that we include delegates representing a variety of disabilities and to arrange for needed accommodations.)

Check ALL that apply:  (you must have at least one disability to be eligible)

___	Orthopedic Impairment			___	Spinal Cord Injury
___	Spina Bifida 					___	Specific Learning Disability
___	Cerebral Palsy 				___	Traumatic Brain Injury	
___	Hard of Hearing/Deaf			___	Autism				
___	Speech or Language Impairment		___	Attention Deficit/Hyperactivity Disorder
___	Visual Impairment/Blindness		___	Mental Retardation/Cognitive Disability     
___	Emotional Disability				___	Other Health Impairment	
		
Other Developmental Disability 	___________________________________________	_____	
 
Other Disability (describe) 											

Please check accommodations that you need to participate at the NCIL Conference:

___ sign language interpreter			___ Braille			___ a reader	
___ lip reading interpreter				___ large print		___ a note-taker/scribe
___ assistive listening device			___ audiotape 		___ wheelchair access	
___ use of a wheelchair for long distances	___ electronic format
___ personal care assistance for assistance with (please specify): 						
															
___ special diet (please specify): 											
___ mobility orientation to the hotel and meeting room facilities
___ other accommodation(s) (please specify): 									

Sleeping Room Accommodations

In order to function in my room and in the hotel I will need:

___ I really need a "wheelchair accessible room"	
___ I can function in a room with wide doorways and adequate space if I have: 
 	___ a tub/shower with grab bars		___ a hand held shower
	___ a shower chair				___ a toilet with grab bars
	___ other: 													

___ a TDD		___ an alarm clock I can feel rather than hear
___ visual alarms and telephone ring/door knock flashing signals

Travel
									
Assistance will be provided with transportation.  Please indicate your needs below:
___ I can arrange my own transportation but will need some assistance with the cost:
				 estimated miles you will be traveling (round trip)
			        approximate gasoline cost
				 estimated salary for a driver
				 cost to ride a bus, the train or other commercial transportation	
___ I will need assistance finding transportation to the Youth Caucus:
___ I need a wheelchair lift-equipped vehicle		___ I can travel in a car or bus
___ I have my own transportation
___ I have my own transportation AND would be willing to provide transportation for someone 		      else in my area. 	

Select either statement a. or b. and sign where indicated. 	

____ a. The information in this application packet is accurate.  I had assistance from 						 in completing the essay; however, the ideas are mine.  If selected I will attend the whole Youth Caucus and will comply with the agreements.

____ b. The information in this application packet is accurate.  I had no assistance in completing the essay.  If selected I will attend the whole NCIL Conference and will comply with the agreement.

															
 Applicant Signature							      Date

If you have a legal guardian, your guardian must also sign this application:

															
 Guardian Signature							      Date

Two written recommendations must be included with your application.  Select two individuals who are willing to write recommendations for you and provide the following information about each:

   Name						   Position/Title

									(	)				
Organization/Relationship					Telephone Number

   Name						   Position/Title

									(	)				
Organization/Relationship					Telephone Number

Have each individual providing a recommendation for you complete one of the Recommendation Forms included at the end of this packet.

Attachments

Please attach the following documents.  The Selection Committee will use these documents in addition to your application form to determine your leadership potential and to ensure that delegates with a variety of experiences are selected.  

I.	Resume´:	Your resume´ should be typed or neatly and legibly written and should show your 
involvement with school and/or community activities, including any offices you have held, club memberships, service learning experiences, after school activities, other learning experiences, and work experiences.  

II.	Essay:	Please respond to the following questions.  Write or type your responses 				on separate paper and attach to your completed application packet.  Please 
do not exceed four (4) pages.  Responses must be double-space and either typewritten or neatly and legibly written.  If using audiocassette please use 500 or words or less.

	1. 	Leadership - How would you define Leadership?

	2. 	Role Models - Based on your definition of leadership, please tell us about one 				person who has positively influenced your life.  How? (Family, teachers, 					counselors, friends, group leaders, public officials or celebrities are appropriate 
Examples).

3. 	Qualifications - What experiences have you had and/or what characteristics do you have that would qualify you to be a delegate to the NCIL Conference and why do you want to attend?

	4. 	Experiences as a person with a disability - Describe one important experience you 			have had as a young adult with a disability in which you needed to be a leader or be 			assertive.  (Please be specific about your example as it relates to your disability).

	5.	Future Plans - During the NCIL Conference, each delegate will develop a 					personal leadership plan.  What possibilities have you considered for your future 			leadership?

III.	Recommendations 
Please attach two recommendations that describe your demonstrated leadership skills or your leadership potential.  Recommendations must be from community representatives (for example, teacher, employer, church, youth group leader, coach, etc.).  The recommendations should be attached to your application in sealed envelopes as specified in the Instructions for Recommendations.  Give this page to the individuals who have agreed to write a recommendation for you (copy as needed or call for additional copies).

Possible Interview
You may be contacted by the Selection Committee to set up an appointment for a phone interview.  You will be provided the accommodations you requested on your application form.  

Agreements

In order to provide a positive, fun, and safe learning experience at the NCIL Conference all delegates will be expected to comply with the following agreements.

If I am chosen to receive a scholarship I will:

1. 	Be punctual to all sessions and activities of the NCIL Conference.

2.	Be at my designated places and stay with my assigned group at all times.  Attendance at all sessions is mandatory.

3.	Maintain a respectful attitude toward peers, mentors, and NCIL Conference staff.  (Inappropriate behavior will not be tolerated).

4.	Respect the facilities (including meeting areas, sleeping rooms and the Capitol).  I understand I will have to pay for any property damage I cause.

5.	Sleep in my assigned room.

6.	Refrain from smoking and using or having in my possession illegal chemicals or alcohol. 

7.	Comply with the NCIL policy to refrain from wearing perfume, cologne, or any scented grooming products.

8. 	Use my cell phone only before 8:00 a.m. and after 10:00 p.m. (In case of an emergency a contact number will be provided for parents/guardians or others who may need to reach you.)

9.	Leave my cell phone in my room or keep it turned off during conference sessions and activities.

Any violations of these rules will result in you being sent home immediately at your own expense.  Your application to the NCIL Conference and signature on this page and the application indicate your acceptance of these agreements.

We emphasize that scholars are chosen to attend the NCIL Conference because of their leadership potential.  Remember the responsibility that goes with the honor of being selected for a scholarship......and plan to have a good time!

															
			    Signature							 Date

Keep a copy of this page and bring it with you to the NCIL Conference so you will remember your agreements.

Remember: Deadline for postmark on mailed application:  April 15, 2015

Note: Applications postmarked after April 15, 2015, will be considered only if space permits.  

National Council for Independent Living (NCIL) Conference

Recommendation Form

Thank you for agreeing to write a Recommendation for 						 to attend the NCIL Conference.  Please answer the following questions and return your recommendation to the potential delegate in a sealed envelope to protect the confidentiality of your comments.  Feel free to type your recommendation on a separate sheet.  If you have questions about the NCIL Conference or about preparing this recommendation, please contact Kathi Young at 304-766-4624, 1-855-855-9743 or Kathi.young@wvsilc.org  

1.	How do you know the applicant?

2.  	What has the applicant done to demonstrate leadership potential within the community?  
(Please by specific).

3.  	Describe the personal qualities of the applicant in your view that show his or her leadership 
potential.  (Please provide an example or illustration).

4. 	How do you think the applicant might serve as a role model or leader for other young adults with disabilities?  (Please be specific).

___________________________________________		________________________________
			Name								Phone

												________________
Signature of Reference						Date

Please complete this recommendation and return it to the applicant in a sealed envelope in time to be included with their application for the NCIL Conference, which must be postmarked by April 15, 2015.

National Council for Independent Living (NCIL) Conference

Recommendation Form

Thank you for agreeing to write a Recommendation for 						 to attend the NCIL Conference.  Please answer the following questions and return your recommendation to the potential delegate in a sealed envelope to protect the confidentiality of your comments.  Feel free to type your recommendation on a separate sheet.  If you have questions about the NCIL Conference or about preparing this recommendation, please contact Kathi Young at 304-766-4624, 1-855-855-9743 or Kathi.young@wvsilc.org  

1.	How do you know the applicant?

2.  	What has the applicant done to demonstrate leadership potential within the community?  
(Please by specific).

3.  	Describe the personal qualities of the applicant in your view that show his or her leadership 
potential.  (Please provide an example or illustration).

4. 	How do you think the applicant might serve as a role model or leader for other young adults with disabilities?  (Please be specific).

___________________________________________		________________________________
			Name								Phone

												________________
Signature of Reference						Date

Please complete this recommendation and return it to the applicant in a sealed envelope in time to be included with their application for the NCIL Conference, which must be postmarked by April 15, 2015.