CLEVELAND STATE UNIVERSITY
SUPPLEMENTAL APPLICATION FOR THE
MASTER OF ARTS IN SPEECH-LANGUAGE PATHOLOGY
This application is for fall semester ________ (year).
I. Personal Information
Full Legal Name
______________________________________________________________________________
Last
First
Middle
List other name(s) that may appear on academic records
_____________________________________________
Sex
Male _______
Female _______
Permanent Address
___________________________________________________________________________
Number and Street
_____________________________________________________________________________________
City
Telephone Home (
State
)
Zip/Postal Code
Work (
)
Cell (
)
Email address
________________________________________________________________________________
II. Verification of Undergraduate Pre-requisites
Below please find a list of the undergraduate courses and requirements that must be completed before
beginning the graduate program in Speech-language pathology at Cleveland State University. These
courses cover content areas that are required by the American Speech-Language-Hearing Association.
The courses may have different names at different universities. Please complete the chart by entering
the department and course number for each content area.
CSU
Dept.
and
Course
Number
Title of course
Semester
Taken(Sem/
year)
Grade
Are you
currently
taking this
course?
When do
you plan to
take this
course?
Institution
Intro to
Communication
Disorders
Phonetics
Intro to Audiology
Clinical Methods
Anatomy and
Physiology of
Speech and Hearing
Mechanism
25 signed/verified
observation hours
II. Verification of Additional Coursework
The following courses must be completed prior to completion of the graduate program in speechlanguage pathology. These courses are NOT required for admission to the graduate program in Speech
and Hearing.
Dept. and
Course
Number
Biological
Science
(human or
animal
sciences)
Physical
Science
(physics or
chemistry)
Title of
course
Semester
Taken(Sem/
year)
Grade
Are you
currently
taking this
course?
When do
you plan
to take
this
course?
Institution
Psychology or
Social Science
Statistics
Speech and
Hearing
Science
Aural
Rehabilitation
By submitting this application, I certify that the information given in this application is complete and accurate. I understand
that making false and fraudulent statements within this application could result in denial or revocation of admission, or
disciplinary actions as determined by the Program.
___ I understand and have read the above and certify that it is true.
Signature of Applicant ____________________________ Date _____________
Please send Supplemental Application by mail to:
Donna Helwig: Manager, Administrative Operations
Cleveland State University
2121 Euclid Avenue, MC 430
Cleveland , OH 44115
Or email the Supplemental Application to: d.helwig@csuohio.edu