APPLICATION FOR PARTICIPATION/FUNDING
PEDIATRIC AURAL HABILITATION PROJECT
 

Name:
Social Security Number:
Area of Interest: SLP/AUD
Phone Number:
Address:
Texas Resident?
Advisor:
GRE Score:
Grade Point Average:
Status of Program: 1st year MS/ 2nd year MS/ PhD
 

Previous Degrees, Institutions:
 

State Your Career Objectives:
 

How would participation in the Pediatric Aural Habilitation Program assist you in preparation for your stated career objective?
 

Do you anticipate difficulties arranging your schedule to participate approximately 10 hours/week?
 

What experiences have you had working with children with hearing loss?
 
 

Please complete the above application and return by mail or e-mail to:
 

Mail to:

Linda Thibodeau
UTD Callier Center
1966 Inwood Road
Dallas, Texas 75235

E-mail to:

thib@utdallas.edu