ACE CoP Interest Form Question Title * 1. LAST Name Question Title * 2. FIRST Name Question Title * 3. Primary Email Question Title * 4. Secondary Email (optional) Question Title * 5. Professional category that most closely aligns with your current educational position. CCC-SLP CCC-AuD CCC-SLP/AuD Speech, Hearing, or Language Scientist Clinical graduate student (MS/MA or AuD) in CSD Research graduate student (PhD) in CSD Question Title * 6. Educational activities in which you most frequently engage (check all that apply) Clinical education/supervision - employed (FT or PT) by a university/college Clinical education/supervision - not employed by a university/college (aka externship supervisor, preceptor, etc) Classroom (didactic) instructor of undergraduate students - employed by a university/college Classroom (didactic) instructor of undergraduate students - employed as an adjunct/PT faculty Classroom (didactic) instructor of graduate students - employed by a university/college Classroom (didactic) instructor of graduate students - employed as an adjunct/PT faculty Mentorship of PhD students CSD professional not currently participating in education (classroom or clinical), but interested in doing so Current graduate student (MS/MA, AuD, or PhD) currently TA-ing CSD courses (any level) CSD student (MS/MA or AuD) interested in being involved in CSD education in the future CSD student (PhS) interested in being involved in CSD education in the future Question Title * 7. How long (rough estimate) have you been serving as an educator - either in a classroom or clinical setting? Please note - this includes serving as an adjunct or part-time instructor or externship supervisor. Never - and I don't have a specific plan to do so yet Never - but I am teaching my first class/supervising my first student soon Less than 6 months About 1-3 years About 3-5 years About 5-7 years About 7-10 years About 10-15 years More than 15 years Question Title * 8. Feel free to share any additional information about your interests if you would like. Done
