SCHOOL OF SPEECH, LANGUAGE, AND HEARING SCIENCES
Bilingual Speech-Language Pathology Certificate
Bilingual Clinical Practicum Summary
To the Student: At the completion of your semester work with bilingual clients, you must obtain the signature of your
supervisor and of the Bilingual Certificate Coordinator as indicated below. This form must be completed to total at least
100 hours of bilingual clinic and must be attached to your Petition for the Bilingual Certificate at the end of your program in
order for you to receive the Bilingual Certificate.
***** DO NOT LOSE THIS FORM OR NEGLECT TO OBTAIN SIGNATURES AT TIME OF SERVICE. *****
Semester
Institution
TOTAL BILINGUAL HOURS:
Total
Hours
Supervisor Name
(Print)
Supervisor Name
Signature