COLLABORATIVE INTERVENTIONS TO IMPROVE ENGLISH LEARNERS’ OUTCOMES
APPLICATION FOR A PROJECT CI²ELO TRAINEESHIP
Address: Red ID#:
City/Zip: Social Security #:
Phone(s): (required by US government)
___ Speech-Language Pathology: M.A. degree and California Credential in Clinical-Rehabilitative Services
___ Incoming 1 Year Graduate Student
___ Incoming 2 Year Graduate Student (currently 1st Year)
___ School Psychology: Ed.S. degree and California Credential in School Psychology
___ Incoming 1st Year Graduate Student
___ Incoming 2 Year Graduate Student (currently 1st Year)
___ Incoming 3 Year Graduate Student (currently 2nd Year) for ___ One Year or ___ Two Years
ORGANIZE YOUR APPLICATION IN A FILE FOLDER (labeled with CI²ELO & your name)
And include the following items.
___ This form including your Language Learning Profile, Essays, and signed Affidavit & Service Obligation
___ A copy of your current transcript. If you are new to SDSU, please submit a copy of your transcript from the
university that awarded your bachelor's degree (unofficial copy is fine) – highlight courses particularly
relevant to CI²ELO.
___ Your vita (or résumé) – highlight experiences particularly relevant to CI²ELO
SEND or DELIVER to:
Speech Language Students School Psychology Students
Vera Gutierrez-Clellen, Ph.D. Katina M. Lambros, Ph.D.
School of Speech, Language & Hearing Sciences Department of Counseling & School Psychology
(SLHS 240) (NE 194)
College of Health & Human Services College of Education
San Diego State University San Diego State University
5500 Campanile Dr. 5500 Campanile Dr.
San Diego, CA 92182-1518 San Diego, CA 92182-1179
Important: Make a copy of this application for your own files/portfolio.
Your Language Learning Profile
Please conduct a self-assessment of your proficiencies in a language other than English; then describe how you
learned this language. If you have proficiency in more than one language other than English, please copy and
NONE, OR TOO
TYPE OF LIMITED TO
PROFICIENCY MENTION LIMITED-1 LIMITED-2 FLUENT-1 FLUENT-2 PRO-1 PRO-2
COMP. basic - of basic - when adults understand understand parents understand understand technical &
children's speak slowly adults talking at when talking about professional speech of professional presentations
communication normal rate school or children others (e.g., IEP)
basic basic conversation fluent parent interview, IEP professional presentations before
conversation with with adults, fluent conversation participation and exchanges and professional audiences
children with children with adults translating technical conversation
basic brief notes personal letters official letters professional letters psychological reports, professional papers and
& messages to parents and inquiries of IEP goals journal articles
basic brief notes personal letters, formal letters, novels professional college level texts in professional journals,
& messages magazines magazines solicitations psychology or technical graduate/
education professional texts
What percent of your time do you use this language: at home _____% in the community _____%
List and briefly describe all of the ways by which you learned this language (e.g., first language; courses in high
school &/or college; formal immersion programs).
ESSAY #1: Knowledge & Experience with Other Languages or Culture(s). Describe the depth and breadth of
your knowledge base in and experiences with languages (plural) and cultures (plural) beyond English and
“Mainstream”-American; include experiences with English-learners. Double-spaced; 1-2 pages in length.
ESSAY #2: Multilingual Challenges in the Schools. Describe the three greatest challenges that school
personnel encounter in multilingual schools. Use your knowledge base and/or experiences to suggest ways to meet
those challenges. Double-spaced; 1-2 pages in length.
ESSAY #3: CI²ELO Responsibilities. If selected as a Project CI²ELO trainee, you will be responsible for your own
learning and for the learning of your fellow trainees. What does that mean to you? What would you expect from
your fellow trainees? How would you ensure that you are attaining necessary learning outcomes? Double-spaced;
1-2 pages in length.
PROJECT CI²ELO: TRAINEE AFFIDAVIT
Project CI²ELO is funded by the U.S. Department of Education, Office of Special Education Programs (OSEP), to
prepare school psychologists and speech-language pathologists who have shared expertise and skills to
collaborate in the provision of classroom-based prevention-intervention services for English-learners. The funded
traineeship includes stipends and modest allowances for conference travel and professional development. A two-
year obligation of services in the public schools is required from Project CI²ELO trainees for each academic year of
Federal Eligibility Requirements - Trainees must:
Be a citizen or national of the United states; or
Be a permanent resident of the United States or its commonwealths or territories, or
Present U.S. Immigration & Naturalization Service documentation of being in the U.S. for other than a
temporary purpose, with the intention of becoming a citizen or permanent resident.
Project Eligibility Requirement - Trainees must:
Be a full-time student in good standing in the SDSU school psychology program or in a school credential
program in speech-language pathology,
Priority is given to trainees that:
Have experience in multilingual schools and/or with English-learners and/or
Have proficiencies in a high needs language in California schools.
Trainees supported by this Project will complete 3-units of CSP 740 Seminar & Practicum: Collaborative
Prevention-Intervention each semester and in addition to the general requirements of their graduate-credential
programs. This course includes the following:
An intensive Institute (1.5 days, Fri/Sat) in September, January, and May.
An intensive project collaboration seminar (Friday afternoons) including discussion of readings and practicum
experiences, cross-disciplinary presentations, and peer coaching.
An ongoing transdisciplinary practicum (4 hrs/wk, TBA) in a multilingual elementary school.
Weaving of specialty content into regular program coursework, e.g., class discussions, papers, case study
Development & maintenance of a cumulative project portfolio.
Additional project requirements:
Documentation of knowledge base for services to English-learners by taking the California Teachers of English
Learners (CTEL) exam until passing all components, even if beyond tenure on the project.
Professional conference participation (i.e., CEC or comparable) – advanced trainees are encouraged to present
a poster or panel.
Participation in project business meetings and special activities (e.g., retreats, field trips).
Participation in project evaluation procedures (e.g., completion of evaluation forms, meetings with external
Signed agreement to the federally required service obligation of two years public school service to students
with or at risk of disabilities for each year of project support.
I hereby certify that:
(a) I meet the federal and project eligibility requirements,
(b) I have provided an honest portrayal of myself in the Project Application,
(c) I understand and agree to meet all project requirements,
(d) I understand that continued participation in and funding from this project is contingent upon satisfactory
completion of project requirements and satisfactory progress in my graduate program,
(e) I understand that involvement in and support by this project is for a maximum of two years,
(f) This project carries a Service Obligation and I have completed that form, and
(g) I have made a copy of this agreement for my own records (to be included in Project portfolio).
please print your name here student number
Acknowledgement And Acceptance Of Service Obligation
For Support From Project CI²ELO
Fed ID #H325K100413
Project CI²ELO is funded by the U.S. Department of Education, Office of Special Education Programs (OSEP), to prepare school
psychologists and speech-language pathologists who have shared expertise and skills to collaborate in the provision of classroom-
based prevention and intervention services for English-learning students who have or are at-risk of high incidence disabilities in
California's public schools. The funded traineeship includes semester and monthly stipends, and modest allowances for conference
travel and professional development. In return for this scholarship, a two-year service obligation is required from Project CI²ELO
scholars for each academic year of support.
“Scholarship” refers to all types of financial assistance received from the project (e.g., stipends, allowances). The service
requirement is based on the period for which the scholar receives assistance, not on the amount of assistance received.
The service obligation provisions of the federal regulations specify that the scholar must serve in a position in which the individual
spends a majority of his or her time providing special education, related, or early intervention services in the schools. Part-time
employment is accumulated toward meeting the equivalent of the full-time service obligation. Supervisors, researchers, and post-
secondary faculty can qualify if they spend a majority of their time with employees, research, or students involved with providing
special education, related, or early intervention services in the schools.
Federal regulations provide for an additional three years beyond the number of years required by the Act to complete the service
obligation. Thus, a scholar with a two-year service obligation, for example, has five years to fulfill that requirement.
The full-time yearlong School Psychology Internship (or its part-time equivalent) may be applied as the first year of full-time
service obligation if the intern does not receive a scholarship from the project during that internship.
The regulations apply to training program dropouts in the same manner as other scholarship recipients. Dropouts who received
scholarship assistance and are not able to meet their service obligation (due to lack of qualifications) must payback their
Exemption to the repayment requirement will be granted if the scholar (a) is unable to continue the course of study or fulfill the
service obligation because of a disability that is expected to continue indefinitely or (b) has died.
Deferral of the service obligation and/or repayment requirement may be granted during the time the scholar (a) is engaging in a
full-time course of study at an institution of higher education, (b) is serving, not in excess of three years, on active duty as a
member of the armed services of the United States; (c) is serving as a volunteer under the Peace Corps Act; (d) is serving as a full-
time volunteer under Title I of the Domestic Volunteer Service Act of 1973, (e) has a disability which prevents the individual from
working for a period not to exceed three years; or (f) is unable to secure employment as required by the agreement for reason of
the care provided to a disabled family member for a period not to exceed 12 months.
Scholars are required to notify the Project CI²ELO office of changes in address, employment setting, or employment status
throughout the duration of the service obligation and their progress toward meeting the work requirements.
If a scholar fails to meet the terms and conditions of this scholarship agreement, or to obtain a deferral or an exemption, the scholar
must repay all or part of the scholarship assistance to the U.S. Secretary of Education as follows: Amount to be repaid is
proportional to the service obligation not completed. The Secretary charges the scholar interest on the unpaid balance owed, and
may impose reasonable collection costs. (1) Interest on the unpaid balance accrues from the date the scholar is determined to have
entered repayment status; (2) any accrued interest is capitalized at the time the scholar's repayment schedule is established; (3) no
interest is charged for the period of time the scholar's repayment schedule is established.
A scholar enters repayment status on the first day of the first calendar month after the earliest of the following dates, as applicable:
(1) the date the scholar informs the Program that he or she does not plan to fulfill the service obligation under the agreement; (2)
any date when the scholar's failure to begin or maintain employment makes it impossible for that individual to complete the service
obligation within the number of years required; (3) any date on which the scholar discontinues enrollment in the course of study.
The scholar must make payments to the Secretary that cover principal, interest, and collection costs according to a schedule
established by the Secretary.
I hereby acknowledge a two-year service obligation in return for a traineeship-scholarship from Project CI²ELO for one academic
year. I understand and accept the terms of service obligation as well as the payback provision of this agreement. I will notify the
Project CI²ELO office of changes in address and employment setting/status throughout the service obligation period and will
complete the annual follow-up forms to communicate my progress toward fulfilling the service obligation.
Signature ______________________________________________ Date ___________________________________
Printed Name ___________________________________________ Social Security #_________________________