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Student Clinical Placements Please fill out the form below to submit your Student Clinical Placements Student Clinical Placements Student Name Student Email Cohort Year (i.e. year admitted to graduate program) Cohort Year (i.e. year admitted to graduate program) DL Cohort 2020DL Cohort 2021DL Cohort 2022DL Cohort 2023TLH Campus Internship TLH or DL program TLH Distance Learning Term for Placement Fall Spring Summer Have you made contact with a site/SLP? Yes No Is that site in EXXAT? Yes No Does EXXAT show an active contract? Yes No Name of site in EXXAT What city are you looking for? Legal Name of Site: Address: Name, Title, and Email (Person Signing the Agreement) Contact Information: Please provide up to two placements and contact information for who might supervise at the sites. If you are human, leave this field blank. Submit Start Over
