Misericordia University - Speech-Language Pathology - Application

SPEECH-LANGUAGE PATHOLOGY - SUMMER CAMP EXPERIENCE
REGISTRATION FORM
Misericordia University Speech-Language Pathology Summer Camp

The priority deadline for SLP Career Camp is May 1, but the department will continue reviewing new applicants on a rolling basis. All campers will be notified of their acceptance in late May.

* There are no additional fees anticipated to this camp for food or lodging as Misericordia University outside of a deposit ($125) which will be used to defray camp costs. Students are responsible for their own transportation to the camp and leaving the camp to return home. Misericordia University will provide transportation while at the camp.

PERSONAL INFORMATION

Participant's First Name:

Last

Gender

Date of Birth

(MM/DD/YYYY)

Home Address

City

State

Zip

Phone

Cell ()-

Home ()-

E-mail address

Shirt size

Small Medium Large X-Large

SCHOOL INFORMATION

High School Attending

High School Address

City

State

Zip

As of September I will be Junior Senior

OTHER INFORMATION

How did you hear about us?

If other, please specify

Name of Home Newspaper

How did you first learn about speech therapy?

What is it about speech therapy that interests you?

What would you like to learn about at this summer camp?

Tell us more about yourself - your interests, strengths, personality, achievements, service, leadership, and other information that would be relevant to your application.

Contact Information:
Tracey O'Day
Speech-Language Pathology Dept., College of Health Sciences
Misericordia University
301 Lake Street, Dallas, PA 18612-1098