Fillable SLPA Application 19FA

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SLPA Application 19FA

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Laramie County Community College
Speech Language Pathology Assistant Program
ADMISSION FORM FALL 2019
Thank you for your interest in the Speech Language Pathology Assistant (SLPA)
Program at Laramie Count Community College.
The Associate of Applied Science (AAS) in Speech-Language Pathology Assistant is
designed to provide comprehensive academic education and practical training for
Speech Language Pathology Assistants (SLPA). The program content is based upon
the recommendations of the American Speech-Language-Hearing Association
(ASHA). In addition to work in the classroom, the program provides students with
the opportunity to gain practical experience in working with clients/patients in a
variety of settings.
This information is available at our website:
www.lccc.wy.edu/programs/speechlanguagepathology
(Print or Type)
Full Name
Today’s Date
Maiden Name/Other Names Used (for transcript purposes)
Address
Application for Fall
Year
Home Phone
Work Phone
Cell Phone
Email
NOTE: Please advise the SLPA program director if there is a change in any
of the information
above so that we may contact you if additional
information is needed.
Do you intend to enroll in the program:
Full-time Part-time Undecided
Step 1.
Official Transcripts and Apply to LCCC Admissions
Forwarded official transcripts to LCCC
Date
Included unofficial for Program Director
Please list all applicable institutions
Step 2.
Provide a copy of your current professional resume outlining work experience and desire to be a
Speech Language Pathology Assistant.
Step 3.
Complete the following prerequisite summary:
High School or College GPA of 2.5 or higher indicated on the transcripts
PLEASE PROVIDE SEMESTER AND GRADE
Prerequisite Course
Semester
Completed
*In
Progress
(√)
Grade Institution
ENGL 1010 – English
Composition
Grade ‘C’ or better
*NOTE: Please provide a signed and dated statement from your instructor of your current grades for all courses
marked “in progress” by the application deadline. Course completion with a ‘C’ or better is required and final
admittance into the SLPA 1500 course and the program will not be allowed if the ‘C’ is not met by the fall start
date.
Step 4.
Submit completed application and materials to the Speech Language Pathology
Assistant Program by
the deadline (August 10, 2019) via mail or email at the
following address:
Laramie County Community College
Speech Language Pathology Program, HS 328
1400 E. College Drive
Cheyenne, WY 82007
STorney@lccc.wy.edu
Students are selected based on the completeness of the application, including the GPA,
completion of ENGL 1010, resume, and date of receipt of application. There are 20 students
allowed per cohort.
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SLPA Application 19FA

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Completed 15 February 2020

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