Name
(Required)
First
Last
Email
(Required)
Phone
(Required)
School
(Required)
What semester and year are you applying for?
(Required)
What venue of care are you applying for
(Required)
Acute care adults
Neonate
Inpatient Rehab
Outpatient
Why are you applying for this venue of care?
(Required)
What experience do you have with healthy term infants (e.g., feeding, babysitting)?
(Required)
What excites you most about a NICU experience? What fears do you have about a NICU internship?
(Required)
What coursework have you completed already?
(Required)
What is your current GPA?
(Required)
What clinical experiences/internships have you already completed?
(Required)
Why are you interested in an internship at UAB? What goals do you have for yourself if you are selected for this internship?
(Required)
What would your previous supervisors say is your greatest strength and weakness?
(Required)
What would your best friend say is your greatest strength and weakness?
(Required)
What are your top two interests in Speech Pathology?
(Required)
What is your learning style?
(Required)
How do you take constructive feedback?
(Required)
On a scale of 1-5, with 1 being unfamiliar/uncomfortable and 5 being comfortable/independent, how do you feel performing the following skills?
Oral Motor Exam
(Required)
1
2
3
4
5
Bedside Dysphagia Exam
(Required)
1
2
3
4
5
Modified Barium Swallow
(Required)
1
2
3
4
5
FEES
(Required)
1
2
3
4
5
Speaking Valve Placement
(Required)
1
2
3
4
5
Language Evaluation
(Required)
1
2
3
4
5
Aphasia Treatment
(Required)
1
2
3
4
5
Apraxia Treatment
(Required)
1
2
3
4
5
Cognitive Evaluation
(Required)
1
2
3
4
5
Cognitive Treatment
(Required)
1
2
3
4
5
Dysphagia Treatment
(Required)
1
2
3
4
5