Questions? Contact Andrea "Deedee" Moxley, Project Manager, Office of Multicultural Affairs, or Melanie Johnson, Membership Program Manager, at step@asha.org. * Indicates a required field |
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ASHA/ NSSLHA Member ID: |
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| First Name:* |
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| Last Name:* |
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| Street Address:* |
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| City:* |
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| State:* |
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| Country (if not US): |
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| Zip Code:* |
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| Home Telephone Number:* |
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| Cell Phone Number:* |
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| Would you accept text messages?* |
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| Email Address:* |
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What is your area of study?* (Select all that apply.) |
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| Which university are you currently attending?* |
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| Campus (if applicable): |
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| University Location:* |
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Please indicate your preference for a mentor. |
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What degree are you currently pursuing?* |
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| What is your expected date of graduation?* (MM/YYYY) |
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What clinical age population best describes your interest?* |
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| Which employment function best describes your interest?* |
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| Which employment facility best describes your interest?* |
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| The following is a list of specialty areas in the field of communication sciences and disorders. Please choose your top 3 areas of interest.* |
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- Accent modification
- Administration/planning for continuing education programs
- Articulation/phonological disorders
- Assistive listening devices
- Augmentative/alternative communication
- Aural (re)habilitation
- Autism
- Balance assessment/treatment
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- Central auditory processing
- Cerumen management
- Cochlear implants
- Cognitive-communication disorders
- Communication improvement (professional speaking)
- Consumer advocacy
- Educational Audiology
- Electrocochleography
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- Electrophysiological measures
- Evoked potential testing
- Fluency and fluency disorders
- Forensic audiology
- Government and social policy
- Graduate personnel preparation
- Hearing aid evaluation
- Hearing aid/product dispensing
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- Intraoperative monitoring
- Language acquisition/disorders
- Laryngectomy
- Learning disabilities
- Managed care
- Marketing
- Multicultural aspects of practice
- Multilingualism
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- Neurogenic communication disorders
- Newborn hearing screening
- Occupational hearing conservation
- Orofacial myofunctional disorders
- Otoacoustic emissions
- Pediatric assessment
- Phonology and phonological disorders
- Quality assurance
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- Reimbursement
- SLP developmental disabilities
- Structurally based speech disorders
- Swallowing disorders
- Tinnitus
- Treatment outcomes and efficacy measures
- Voice disorders
- Wellness programs
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| In addition to English, I speak fluent: |
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Please provide a brief overview of your career goals.* |
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How did you hear about this program?* |
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| What is your sex?* |
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| Which of the following best describes your ethnicity?* (Select one.) |
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| Which of the following best describes your race?* (Select all that apply.) |
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