Northern California LEND Application 2026-2027

First Name (your legal name)

(optional) Preferred Name: (nickname or preferred first name- for every day use)

Secondary / Permanent Email

(*enter at least one email address not affiliated with a school or university, here or above)

Phone Number
(please use format (999) 999-9999)

Phone Type

US County of Origin (examples: El Dorado, Placer, Sacramento, Yolo) 

California Resident
Will you be residing in California for the LEND training year (September 2026-June 2027)?

Please note that all LEND trainees must reside in California for the duration of the LEND training year.

Phone
(Please use format: (999) 999-9999)

Permanent Contact Email

Date of Birth
(Please use format: mm-dd-yyyy)

Biological Sex

(per Federal Reporting requirements)

Race (check all that apply)

Race

If you selected American Indian and Alaska Native, please include your Tribe name here:

Ethnicity (check one)

Hispanic is an ethnic category for people whose origins are in the Spanish-speaking countries of Latin America or who identify with a Spanish-speaking culture. Individuals who are Hispanic may be of any race. 

United States Residency Status

Due to HRSA federal funding, we are restricted to accepting trainees who have permanent residency or US citizenship.

UC Davis / UC Davis Health Affiliation(s):

(check all the apply)

If you do have an affiliation with the UC system (past or current), please provide your UC email (past or current) here:

UC Davis Employee Requirements

If accepted into the LEND program, you will be required to follow UC Davis Health Employee mandates for health clearance, including COVID and flu vaccinations and a background clearance. These and other onboarding requirements through UC Davis Health typically take about 9 hours in total and are non-optional. Please select one of the 2 statements:

(additional information regarding these requirements will be made available before the start of the program.)

Do you speak a language other than English at home?

per Federal Reporting requirments

If you speak a language other than Spanish and English at home, what is the language(s)?

Are you able to write in a language(s) other than English?

If you are able to write a language(s) other than Spanish and English, what is the language(s)?

Are you fluent or a native speaker of another language(s) other than English? (check all that apply)

This information helps us determine your LEND community and clinical placement options.

Please Select your Relationship to Disability (Check all that apply)

"Disability" refers to a varied group of severe chronic conditions that are due to mental and/or physical impairments that substantially restricts functioning in several major life activities. Examples include autism, fetal alcohol syndrome, behavior disorders, Down syndrome, brain injury, fragile X syndrome, cerebral palsy, intellectual disabilities, spina bifida, and mental/behavioral health disability.

A person with a "special health care need" has or is at increased risk for having chronic physical, developmental, behavioral, or emotional conditions. They have conditions such as asthma, sickle cell disease, epilepsy, anxiety, autism, and learning disabilities. They may require more specialized health and educational services to thrive, even though each person's needs may vary.

If yes, what accommodations do you require?

(check all that apply)

If you require other/additional accommodations, please describe what you will need:

*Note: LEND works with the UCD Disability Management Services to identify needs and supports of our trainees. Together, we determine available disability supports but cannot guarantee all requested accommodations can be provided.

First-generation College Student 

First-generation college students are students who were at any time enrolled in postsecondary education and whose parents do not have any post-secondary education experience.

Highest Academic Degree/Credential achieved

Current Academic Level (Current enrollment status, not highest degree earned)

Academic Degree Program for which you are currently enrolled (e.g., BA, MA, MSW, PhD, or "N/A", if not currently a student)

(if applicable) Position in Degree Program

(if applicable) Expected Completion/Graduation Date from degree program

Primary Discipline (Select one)

What is a discipline? Your discipline is your background, your academic area of study, or the primary focus of your work or interest. Your Primary Discipline can help determine the area(s) of your LEND training. 

For Long-term trainees, this question will help us determine your mentor.

If you have any questions about how to select your Primary Discipline, please reach out to lend@health.ucdavis.edu

Additional Discipline(s) (Check all that apply)

Please select all other disciplines that apply to you in addition to your selected primary discipline above. 

You may reference the definitions below to clarify some of the discipline choices marked with an *.

• "Disability" refers to a varied group of severe chronic conditions that are due to mental and/or physical impairments that substantially restricts functioning in several major life activities. Examples include autism spectrum disorders, fetal alcohol syndrome, behavior disorders, Down syndrome, brain injury, fragile X syndrome, cerebral palsy, intellectual disabilities, and spina bifida.
• A person with a "Special Health Care Need" has or is at increased risk for having chronic physical, developmental, behavioral, or emotional conditions. They have conditions such as asthma, sickle cell disease, epilepsy, anxiety, autism, and learning disabilities. They may require more specialized health and educational services to thrive, even though each person's needs may vary.
• "Person with Lived Experience" include individuals with knowledge and experience on health or social issues that is gained through direct, first-hand involvement in everyday events; lived experience include knowledge based on someone's perspective, personal identities, and history beyond their professional or educational experience. (This term often applies, but is not limited to, self-advocates and family members of a person with a disability).

If you selected "Person with a Disability" as one of your disciplines, please let us know how you would like to be referred. One common term used is "self-advocate."

Who is a self-advocate? "Every disabled person is a self-advocate. There is no such thing as being "too disabled" to be a self-advocate. Self-advocacy means taking control of our own lives. That can mean making choices about how we live our lives, like choosing what we do at home, at school, at work, or in our relationships. It can also mean working as a community to take control over how society views disabled people, how the media talks about us, and policies that affect our lives." [source: Autistic Self Advocacy Network]

Examples of other terminology: Self-advocate, autism advocate, person with autism, autistic person, neurodivergent, person with a disability, disability-advocate, etc.

Different settings where we may share your discipline:

• To other LEND trainees, faculty and team members
• To community and clinical members
• On the LEND website

NOTE: If your preferred term varies depending on the setting, feel free to let us know. The LEND team will confirm your preferred identify terminology once accepted to the LEND program. 

Which LEND trainee track(s) are you interested in?

(Check one or more)

To see a chart of the LEND Trainee Tracks click here and scroll to "LEND Trainee Levels"

Note for Long-term Trainees:

• • New Trainee Orientation (1 full day in September, 8 hours)
  • Trainee Year-end Presentations & Graduation (1 day in May, 5 hours)
  • Community Placement(s) - minimum 5 hours
  • Clinical Placement(s) - minimum 5 hours

Do you currently work with a faculty mentor who is affiliated with the LEND?

Examples include Charleen Singh, Katrin Mattern-Baxter, Robin Stewart.

How did you hear about the LEND program? (e.g., MIND website, Facebook, department listserv, etc.)

Letter of Interest:

Please explain your interest in the LEND program, professional and/or personal experiences with autism/neurodevelopmental disabilities, any interest in working with a wide range of populations, and career goals. If you have any unique experiences or background related to disabilities, culture, etc. that would make you an especially good LEND trainee, please describe.

Letter of Recommendation #1

(*If your letter provider would prefer to send their letter separately, please have them email it to lend@health.ucdavis.edu)

Letter of Recommendation #2

(*If your letter provider would prefer to send their letter separately, please have them email it to lend@health.ucdavis.edu)

Communication Sample

If you have a bachelor's degree or higher, please submit an example of your communication skills. This could be a writting sample (such as a college essay), a video, or audio recording of an oral presentation, discussion, or interview.

(Optional) Upload other file not specified in application