SPCHSCI 701 Dysphagia for Speech Language Therapists

Section 1 - Personal details

Which semester do you intend to enrol in?

Full name

Email address

Phone number

University of Auckland ID (if known)

Country/countries you will be located in during this course

Note: If you change your address details during the selection and enrolment period, please advise the School of Psychology and ensure you have updated your details on Student Services Online.

Section 2 - Academic, work and research experience

a) List your university-level education and any professional qualifications that you hold:

Include the name of the institution, the name of the qualification/degree and the date attained.

Upload your academic transcript:

Upload file

b) List any education, employment or voluntary experiences with dysphagia:

Position:

Dates:

Organisation:

Describe duties:

Position:

Dates:

Organisation:

Describe duties:

List any sources of support or supervision for yourself in relation to dysphagia, external to the University of Auckland. These are in no way detrimental to your application.

We encourage you to connect with your course mates online and also seek external support whilst you are engaged in this online course.

Section 3: Personal statement of academic and research interests

Describe your motivations for pursuing this course in dysphagia, together with your interests in the area, and any previous experience in this subject. Please also briefly describe previous experience with online learning (maximum 500 words).

Personal statement of academic and research interests:

Section 4: Confidentiality and declarations

Confidentiality requirement for students enrolled in Speech Science courses

Within Speech Science courses students will observe and discuss video material, and/or participate in class discussions involving confidential information about people with swallowing disorders and/or from other vulnerable populations.

It is essential that students treat as confidential any information they receive in the course of their studies in Speech Science. They will not disclose information about people participating in the coursework or classroom teaching for students in Speech Science. They will treat as confidential any personal or identifying information about individuals or families/whanau that people share in this context.

Declaration:

I agree to maintain the confidentiality of case examples or participants in any Speech Science learning activity. I will not disclose the names or any identifying details of people who are participating in Speech Science academic, research or clinical course activities nor will I discuss this information with anybody other than classmates and staff in the Speech Science programmes.

I declare that the information I have given in this application form is true and accurate. If statements I have made are found to be false or inaccurate, I acknowledge that my application may not proceed.

Please do not enter any credit card information into this form.

SPCHSCI 701 Dysphagia for Speech Language Therapists - supplementary application form