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ACE CoP Interest Form
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1.
LAST Name
(Required.)
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2.
FIRST Name
(Required.)
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3.
Primary Email
(Required.)
4.
Secondary Email (optional)
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5.
Professional category that most closely aligns with your current educational position.
(Required.)
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
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6.
Educational activities in which you most frequently engage (check all that apply)
(Required.)
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
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
8.
Feel free to share any additional information about your interests if you would like.
