CLINICAL EXPERIENCE SUMMARY
School of Communicative Disorders
University of Wisconsin-Stevens Point
Please provide the following information concerning your clinical
observation and clinical practicum experiences and return it with your
Application for Admission to the School of Communicative Disorders. In
addition, if you have been employed in the field of communicative disorders,
please describe your job on a separate sheet of paper. Please include
information such as your employer, dates of employment, types of cases
served, and any other relevant information about your position.
(1) Have you completed 25 hours of
clinical observations? Yes ____ No ____
If no, how many hours have you completed? ____
Do you expect to complete 25 hours of clinical observations prior to
entering graduate school? ____
(2) Have you earned clinical hours
as an undergraduate? Yes ___ No___.
If Yes, please complete the blanks below with the number of hours you have
earned. Include only those hours
earned under the supervision of someone holding ASHA Certification.
A. Therapy clock hours:
B. Diagnostic clock hours:
Adults
Children
Adults
Children
Speech
________ _______
Speech
________ _______
Language
________ _______
Language ________
_______
Aural Rehab/
Hearing Eval/
Hearing
________ _______
Screening ________
_______
Treatment
TOTALS
________ _______
TOTALS ________
_______
(3) How many additional clinical
hours do you expect to complete prior to entering graduate school?
_________
Your Name: ___________________________________
Date: _____________________
2/11/2010