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Speech Fellows Request Form

Fill out the form below to request a fellow for your class. Please email Jeanne Hollister with a copy of the syllabus and particularly assignments related to speaking or formal discussion in class to accompany your form.

Faculty Member’s Name:
Email:
Phone:
School and Department:
Semester:
Year:
Course Name and Number:
Class Meetings Days and Time:
Number of Students Enrolled:
I would like to request a Speech Fellow for the purpose of providing assistance to students enrolled in the class listed above. This assistance should include (check appropriate items):
Work with individual students at the Speech Center
Indicate minimum number of consulting sessions per student:
Work with groups of students at the Speech Center
Indicate minimum number of sessions per group:
Regular class attendance by the speech fellow
Occasional class attendance (Dates indicated on attached)
Conduct of practicum or lab outside class time
Indicate approximate number of labs and duration of each lab
practicum/labs per semester
hours/practicum/lab
Special preferences or requests for the consultant who serves as my speech fellow: