National Academy of Preprofessional Programs in Communication Sciences and Disorders

2008-2009

Sign-up Form

 

Program Name: _____________________________________________________________

 

Address: __________________________________________________________________

 

Contact Person: _____________________________________________________________

 

Email Address: _____________________________________________________________

 

Phone: _____________________________________

 

FAX # _____________________________________

 

Names of Academic Faculty: _________________________________________________

 

___________________________________________________________

 

Names of Clinical Staff: ____________________________________________________

 

___________________________________________________________

 

To pay your annual dues, please print and send your application and a $50.00 check payable to the National Academy of Preprofessional Programs by February 1, 2006:

 

Mary Steppling

Columbia College

1301 Columbia College Drive

Columbia , SC 29203

 

You can always pay early, if you wish!