Step 1: Select and complete the application for enrollment into the summer clinic or camp.

Application: Please fill out this application in its entirety. You must fill out the entire application in order to be eligible for participation in the summer program.

Step 2. Complete the Mutual Exchange and Consent Forms.

Mutual Exchange of Information Form: The information you provide on this form will give us permission to contact your most recent Speech-Language Pathologist. You must include the signed “Consent for Mutual Exchange of Information Form” when you submit your application to our summer clinic

Consent Form: Please read the “Consent Form” carefully so that you are informed of your financial obligations, the services we provide, and the type of recordings that may take place while you are enrolled in the summer clinic. The consent form must be signed and on file in the clinic prior to the initiation of services. If you have any questions about this form, please call us prior to your visit. You must include the signed “Consent Form” when you submit your application to our summer clinic.

Step 3. Review the UW Speech and Hearing Clinic Notice of Privacy Practices and sign the UW Consent for Care document.

Privacy Practices: This handout describes how medical information about you may be used and disclosed and how you can get access this information. Please review this notice carefully.

UW Consent for Care: Please read and sign this document to acknowledge the receipt of the clinic notice of privacy practices.

Step 4: Return the application, mutual exchange, and consent for services documents in person or mail to:

UW Speech and Hearing Clinic
Jill Jones-Redmond /Summer Clinics
4131 15th Ave NE
Seattle, WA 98115

APPLICATION DEADLINE: February 27th, 2009

Please Note: We must review the application to determine if the individual will be an appropriate candidate. Even if you send in a completed application, we cannot guarantee services. If the individual is eligible, you will be contacted to schedule a comprehensive pre-assessment prior to summer treatment.