WSHA/Viterbo University Graduate Credit Form
Please check the appropriate information to validate your attendance at each session of the WSHA
Convention/course. Use the space below the session to indicate the title/presenters for each session you
attend, what you have learned from the session and related it to the readings you select. You may attach
additional pages, if necessary to support your findings.
FIFTEEN HOURS OF ATTENDANCE IS REQUIRED. YOU MUST ATTEND FULL SESSIONS TO COUNT HOURS.
THURDAY, FEBRUARY 26, 2015 (PRECONVENTION SESSIONS)
AFTERNOON SESSION: (2:00 – 5:00 p.m.) Please list session attended.
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EVENING SESSION: (6:00 – 9:00 p.m.) Please list session attended
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FRIDAY, FEBRUARY 27, 2015
(7:30 – 9:00 a.m.) Note session attended: Legislative Updates
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BLOCK 1 (10:00 am - 12:00 pm) Various sessions offered. Please note session(s) attended and time of
session(s) attended.
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LUNCH 12-1:00 in Exhibit Hall
BLOCK 2 (1:15-3:15 p.m.) Various sessions offered. Please note session(s) attended and time of session(s)
attended.
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BLOCK 3 (3:45-5:45 p.m.) Various sessions offered. Please note session(s) and time of session(s) attended.
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SATURDAY, FEBRUARY 28 2015
GENERAL SESSION: 9:00 – 10:00
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BLOCK 4 – 10:15 – 12:15 Various sessions offered. Please note session(s) and time of session(s) attended.
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LUNCH PRESENTATIONS 12:30 – 1:30 p.m. Note session attended.
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BLOCK 5 (1:45 – 3:45 p.m.) Various sessions offered. Please note session(s) attended and time of session(s).
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BLOCK 6 (4:00 – 5:00 p.m.) Various sessions offered. Please note
session(s) attended and time(s).
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This form must be turned in to a WSHA representative on Saturday, February 28, 2015 at the end of the
convention/course OR it may be mailed to the instructor for this course: Kate Morand; PhD, CCC-SLP; 453
North Baldwin Street; Madison, WI 53703. The instructor must receive this form no later than Saturday,
March 14, 2015. Please DO NOT email this form to the instruction; paper submissions only will be accepted. If
you want confirmation that your paper was received, please include your email address below and an email
confirming receipt will be sent by the instructor. The instructor will review this form for validation of hours
and quality of content based on the grading rubric received at students’ registration.
By my signature I validate my attendance and participation as noted above.
SIGNATURE__________________________________________________________________ Date__________
Print Name________________________________________________________________________________
Address___________________________________________________________________________________
City______________________________________________________State____________Zip______________
Phone___________________________________Email_____________________________________________
Instructor Signature__________________________________________________________ Date___________
Wisconsin Speech-Language Pathology and Audiology Association
563 Carter Court – Suite B
Kimberly, WI 54136
(920) 560-5642 phone ٠ (920) 882-3655 fax
www.wisha.org