Please complete and submit the following student interest profile.


If you have any questions, feel free to contact Ann Telfer, Community Relations Manager:
UCLL
1111 E. Catherine Street
Ann Arbor, MI 48109-2054
atelfer@umich.edu
734-764-8440
734-647-2489 (fax)

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All fields marked with an asterisk (*) are required.
Name *
Address *
Email *
Phone *
Student ID# *
Currently enrolled in which department at UM. *
Anticipated Degree/YOG *
Are you planning on attending graduate school in speech-language pathology? * Yes No
Describe your interest in speech-language pathology. *
Summarize previous work experiences in jobs related to education, linguistics, or psychology. *
What specific types of experiences are you interested in receiving from this field placement? *
Time Commitment: This 1 credit course is approximately 4 hours a week including 1 hour of instructional time every other week designed to increase your knowledge of best practices in the application of clinical methodologies. We have scheduled this instructional time every other Tuesday, from 12:00 - 1:00 p.m. Can you commit to this scheduled instructional session? * Yes No