Speech Language Pathology Assistant Program Application

Speech Language Pathology Assistant Program Application
Applicants must meet all admission criteria for Danville Area Community College and must have an official high school transcript or GED on file with DACC Records.

SLPA admission committee will collect cumulative GPA from all institutions attended as apart of this application process.

Applicants are required to upload unofficial transcripts from any institutions attended including DACC.

Applicants must be able to perform the essential functions of the Program, and must therefore meet the Technical Requirements of the Program.

If all seats are filled for the current semester, remaining qualified applicants must submit another SLPA Program application for the following admitting semester. Applications and waiting lists of qualified applicants will not be maintained from semester to semester.

All prerequisite courses must be completed with a C or higher before applying to the SLPA program.
- SLPA 101
- SLPA 102
- BIOL 136
Name

First NameLast Name
DACC Email
example@example.com
Personal Email
example@example.com
Phone Number
DACC Student ID
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work/Employment History-Include company name, dates, and supervisor/contact for verification. Applies to paid or unpaid work experience.
Community Volunteerism-Include organization name, dates, and supervisor/contact for verification. May include community, civic, or faith-based volunteer experiences (e.g., church, youth group, food pantry, community center, etc.).
Membership in Professional, School, or Service Organizations- Includes participation in professional, school-based, community, or service organizations. Examples: ISHA, AMBUCS, Rotary, National Honor Society, FFA, FCA, Student Council, Key Club, etc.
Personal statement 300-500 words: Explain why you want to become a Speech-Language Pathology Assistant and how your experiences and goals have prepared you for this field (300–500 words)

0/500

Have you ever been charged with or convicted of a misdemeanor or felony? (This includes court convictions and military courts-martial.) If no, type no. If yes, please explain.
Answer "Yes" if you have:- Charges or convictions-including those that were stayed, withheld or deferred, set aside, or suspended- Any plea of guilty, Alford plea, or plea of no contest (nolo contendere) -Court conditions applied to your charge-including court supervision, probation, or pretrial diversion-Traffic violations charged as misdemeanors or felonies-Traffic violations that involved drugs or alcohol
By signing below, you agree to the following:

I understand that any false or misleading statements made by me on this application will prevent my acceptance into the program or may be cause for dismissal if accepted.

I understand and accept that after being admitted to the program, I must pass a physical examination approved by Danville Area Community College. I understand that I will be asked to authorize the release of my health and demographic information to the clinical sites utilized by the SLPA program.

As required by the clinical affiliates, students must undergo criminal background checks before entering the program. This form will be sent to you upon your acceptance to the program. I also understand that if the background check results prevent me from participating in the clinical sites, I will not be able to enter the program. At DACC, we updated all of our program manuals to state: “DACC does not rely on drug test results to deny access to any academic program for any student who is 21 or over and tests positive for marijuana. However, all clinical sites require a test for marijuana and do not allow students to complete clinicals if the test is positive. The clinical is a requirement of this program; thus, if DACC does not have a clinical partner that allows positive tests, students will not be able to complete the program and will be dismissed.

If you have any questions relative to the interpretation of any part of this application, please email SLPA@dacc.edu
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Completed Degrees- Please state all completed degrees (highschool, college, certificate program, etc).
Unofficial Transcripts

Please upload unofficial transcripts from all institutions attended.
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Upload any additional pieces of documentation you would like to include with your application. This can include proof of certification, licensure, resume, etc..

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By signing below and submitting your application, you agree and understand the following:

Current immunization status must be completed as specified in the acceptance packet. A physician’s exam must also be completed, indicating the applicant meets the technical requirements of the SLPA program regarding physical, emotional, and mental skills and abilities, or that reasonable accommodations will be requested. Drug screening is done on admission and on an “as needed” basis. Any student with a positive drug screen will be considered ineligible for the program. Consideration for readmission or any admission after a positive drug test will require three negative screens after one year of application. Testing is at the student’s expense. Students must adhere to DACC’s drug-free policy and must meet the criteria of each clinical site utilized by the Program. Being under the influence of alcohol, illegal drugs, or any other behavior-altering substance during class/clinical/lab instruction is grounds for immediate dismissal from the SLPA program. If an instructor suspects a student is under the influence, the instructor has the right to request a drug screen at the student’s expense. Please NOTE: Marijuana, even if certified under the Illinois Public Act 101-0027, remains illegal under federal law, which constitutes an illegal drug, and is a Prohibited Substance according to clinical sites’ policies. Prescription marijuana is also prohibited if intoxicating effects are observed at the clinical site. Applicants accepted into the Program must submit the Criminal Background Check Form by the date specified on the acceptance packet. Failure to submit the form by the due date will be considered a declination, and the seat will be offered to the next qualified applicant. Students considering application to the program need to be aware of criminal background checks for SLPA program clinicals and potential legal limitations on licensure.
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Speech Language Pathology Assistant Program Application

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