Speech Fellows Request Form

Fill out the form below to request a speech fellow for your class, and we will contact you regarding your request and any questions you may have about this process. Please email Weinstein Learning Center Coordinator Emily Ball a copy of your assignment instructions and/or syllabus. Paper copies and digital files will be made available in each of the studios for the fellows and students to reference as they work. We ask that requests be made prior to the start of the semester, or as as soon as you know you would like to utilize this service. Requests are filled on a first-come, first-served basis.

Once you have recieved confirmation that your request has been filled and you have been put in touch with your speech fellow(s), please share our Appointments page with your students and meet with your assigned fellow(s) to discuss expectations for the semester.

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 Work with groups of students at the Speech Center Regular class attendance by the speech fellow Occasional class attendance (Dates indicated on attached) Conduct of practicum or lab outside class time

Indicate minimum number of consulting sessions per student:
If working with individual students

Indicate minimum number of sessions per group:
If working with groups of students

Indicate approximate number of labs:
# of practicum/labs per semester

Indicate approximate duration of each lab:
# of hours/practicum/lab

Special preferences or requests for the consultant who serves as my speech fellow

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Speech Fellows Request Form