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. __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ EVENING SESSION: (6:00 – 9:00 p.m.) Please list session attended __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ FRIDAY, FEBRUARY 27, 2015 (7:30 – 9:00 a.m.) Note session attended: Legislative Updates __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ BLOCK 1 (10:00 am - 12:00 pm) Various sessions offered. Please note session(s) attended and time of session(s) attended. __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 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. __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ BLOCK 3 (3:45-5:45 p.m.) Various sessions offered. Please note session(s) and time of session(s) attended. __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ SATURDAY, FEBRUARY 28 2015 GENERAL SESSION: 9:00 – 10:00 __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ BLOCK 4 – 10:15 – 12:15 Various sessions offered. Please note session(s) and time of session(s) attended. __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ LUNCH PRESENTATIONS 12:30 – 1:30 p.m. Note session attended. __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ BLOCK 5 (1:45 – 3:45 p.m.) Various sessions offered. Please note session(s) attended and time of session(s). __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ BLOCK 6 (4:00 – 5:00 p.m.) Various sessions offered. Please note session(s) attended and time(s). __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 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