Forms

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Speech-Language-Hearing Clinic Forms

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Contact Log [MS Word] 

Encounter Form [MS Word] 

End of Rotation Requirements [MS Word] 

End of Session Clinic Case Recommendation [MS Word]

Fee Schedule for Speech Language Clinic [Word] 

Observation at the NAU Clinic [Word] 

Observation form for Evaluation [Word]

Observation form for Treatment [Word]

Parent/Client Rating of Clinical Service [Word] 

Recommendation Following Evaluation [Word] 

Treatment Notes [Word] 

602 and 608 Required Forms

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Affiliation Agreements - Information Needed from the Site

ASHA Code of Ethics [Word] 

Caseload Feedback [Word] 

Clinical Competency Evaluation [Word] 

Clinical Practicum Information [Word]  

Confidentiality Statement [PDF]  

CSD 602 Guidelines [Word] 

CSD 608 Guidelines [Word]

Daily Log [MS Excel Worksheet] 

Daily Log Supplemental Instructions [Word] 

Employment Following Graduation [Word] 

Exit Survey [Word] 

Externship Information [Word] 

HIPAA Test 

HIPAA Tutorial [PPT] 

Interviewing and Affiliation Agreements - Student Information

Praxis Exam Follow-Up [Word] 

Reflective Review [Word] 

Registration Checklist for Clinical Experience [Word] 

Review of Externship Site [Word] 

Self Evaluation [Word] 

Standards for Certificate of Clinical Competence in SLP [PDF]  

Student Responsibility Statement [Word] 

Synopsis of Arizona Licensure [Excel] 

Other Forms

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Employment Information Update for Summers-Only Students [Word]

Hearing Screening Hours [Word] 

Individualized Study Contract, CSD [Word] 

Knowledge and Skills Acquisition [Word] 

Observations at a Non-NAU Site [Word] 

Troubleshooting Registration Problems [Word]

Request for Pre-Approval to Take an Elective [Word]