Name

Degree Year Granting institution

Current affiliation Current position/rank Years in current position

Telephone: home cell work

Address

City State Zip

Email Current CCC/SLP? Yes or No

Specialty certification? Yes or No

Courses/clinical experiences presently offered

Courses/clinical experiences planning to offer

Please describe any previous and current research activities

Please describe previous and current clinical activities

Part of the workshop experience is getting to know other SLPs who are interested in the treatment of stuttering.Therefore, all participants are required to stay in a dormitory throughout the workshop. By initialing here, you are indi-cating that you understand and will comply with this requirement. _____

In December 2020, you will be contacted by the workshop leaders and the Stuttering Foundation to evaluate theimpact of the workshop. By initialing here, you agree to provide written feedback when contacted. _____

Please attach a one-page description of the reasons you would like to participate in this workshop. As part of your response,please describe:

(1) What, if any, things you have tried/changes you have made in your teaching that you hoped would positively impact studentlearning. Have they been successful? How do you know?

(2) What you hope to gain from participating in this workshop, and how this information/experience will impact (a) your existingand/or future courses, (b) your existing and/or future clinical supervision, and (c) the potential short- and long-term effect yourparticipation will have on the lives of people who stutter and their families.

Mail to:Dr. Ronald ShaferThe Stuttering Foundation1805 Moriah Woods Boulevard, Suite 3Memphis, TN 38117

IMPORTANT: Applications must be received via mail no later than March 31, 2020

THE STUTTERINGFOUNDATION

901-761-0343 www.StutteringHelp.org

A Nonprofit Organization Since 1947 — Helping Those Who Stutter

The Stuttering Foundation Iowa Workshop for Faculty DevelopmentDesigning Coursework and Clinical Experiences

in the Nature & Treatment of StutteringJUNE 8-11, 2020

Co-sponsored by The Stuttering Foundation and The University of Iowa

If you require more space, please attach additional pages

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Objective: This four-day workshop will provide faculty and graduating doctoral students with practical strate-gies for developing undergraduate and graduate courses and clinical experiences in stuttering for students inCommunication Sciences and Disorders degree programs.

Workshop Faculty: Vivian Sisskin, M.S., CCC-SLP University of Maryland Jennifer Watson, Ph.D., CCC-SLP Texas Christian University Patricia Zebrowski, Ph.D. CCC-SLP University of Iowa

Representing the Stuttering Foundation: Jane Fraser, President

Workshop Format: Instructors will present a comprehensive didactic and clinical curriculum in the natureand treatment of stuttering across the lifespan. The workshop will include presentations and discussion relat-ed to designing course content and clinical experiences, choosing relevant resources (readings, video andaudio materials), constructing syllabi, developing PowerPoint presentations and both in- and out – of - classand clinic activities and assignments, as well as methods for evaluating student performance.

Participants: This intensive workshop is intended for faculty who (1) have recently started teaching didacticcoursework in stuttering, (2) for doctoral students who are preparing to teach courses in the nature and treat-ment of stuttering upon completion of their degree, or (3) for faculty who are primarily responsible for super-vision of student practicum in the treatment of stuttering . We also invite experienced faculty who are look-ing for ways to update or enhance existing courses, particularly for those who want ideas for linking researchto clinical practice.

Costs: The Stuttering Foundation provides all conference fees and lodging costs, which includes a per diemfor meals. Attendees are responsible for their own travel arrangements.

Accommodations: Workshop attendees will stay in single-occupancy student dorm rooms in the same facilityon the University of Iowa campus in Iowa City, IA. The workshop begins on Monday, June 8, with youranticipated arrival the preceding afternoon or evening on Sunday, June 7, 2020. The workshop ends onThursday, June 11, with your departure on Friday, June 12.

Deadline: All applications must be received via mail no later than March 31, 2020.

Please mail application to:Dr. Ronald ShaferStuttering Foundation1805 Moriah Woods Boulevard, Suite 3Memphis, TN 38117

THE STUTTERINGFOUNDATION

901-761-0343 www.StutteringHelp.org

This course isoffered for 2.7ASHA CEUs(Advanced level,Professional area).

The Stuttering Foundation Iowa Workshop for Faculty DevelopmentDesigning Coursework and Clinical Experiences

in the Nature & Treatment of StutteringJUNE 8-11, 2020

Co-sponsored by The Stuttering Foundation and The University of Iowa

FINANCIAL DISCLOSURESJennifer Watson receives a faculty salary from Texas Christian University. Shereceives an honorarium from the Stuttering Foundation for teaching this workshop.Vivian Sisskin receives a faculty salary from the University of Maryland. Shereceives an honorarium from the Stuttering Foundation for teaching this workshop.Patricia Zebrowski receives an honorarium from the Stuttering Foundation forteaching this workshop.

NONFINANCIAL DISCLOSURESNone

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