American Speech-Language-Hearing Association

Application for ASHA School Programs Input (SPI) Group

ASHA's School Services team has established a group of school based practitioners interested in providing feedback to our team on a variety of issues. These issues may range from input on federal regulations, newly developed products, emerging issues, etc. As issues arise, you would be sent a brief e-mail describing the issue, asking for specific feedback to be provided within a designated period of time. We also invite participants to independently provide us with information about anything of concern to you. All communication would take place via e-mail, and your feedback would be handled confidentially.

If you are interested in becoming a member of this group, please complete the following form.

If you have any questions, please contact Deborah Adamczyk, ASHA Director of School Services, at dadamczyk@asha.org.

* indicates required field.

First Name:*

Last Name:*

Today's Date (MM/DD/YYYY):*

Account Number:*

Mailing Address:*

City:*

State:*

Zip Code:*

Phone Number:*

E-mail:*

Are You a School-Based:*

Audiologists and SLPs

Please check the categories that best represent your setting.

Work Setting:*

*If other, please specify.

Grade Levels Served:*

District Size:*

Number of Years Working in School Setting:*

Are you an employee of the district or do you contract to provide services?*

Type of Caseload:*

* If specialized caseload, please specify.

** If other, please specify.

SLPs

Please also provide the following information.

Are you supervised and/or supported by a supervisor certified as an SLP?*

Are you assigned according to workload or caseload?*

Where do you conduct most of your therapy sessions?*

What percentage of your caseload receives 1:1 therapy?*

Briefly describe why you would want to be part of our input group.*

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