APPLICATION FOR PARTICIPATION/FUNDING
PEDIATRIC AURAL HABILITATION PROJECT
Social Security Number:
Area of Interest: SLP/AUD
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:
UTD Callier Center
1966 Inwood Road
Dallas, Texas 75235