Address_______________________________________________________________                               Street                                         City                                               State                           Zip

Phone # (____)____________________          Cell Phone # (____)____________________

I am planning to pursue academic course work which will qualify me to work as:

               _________Certified Teacher of the Deaf (Hearing Impaired)

               _________Certified Speech Language Pathologist

I became interested in this field of study because:

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

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My cumulative grade point average (GPA) is ________. 

I will begin my course work _____________________
                                             (semester/year)

The following items should be sent to the Department address above:

1. Return this completed form.
2. Student Code of Ethics form signed and dated.
3. Admissions and Retention Criteria form signed and dated.
4. Attached copies of transcripts. (Transcripts must be attached before your application can be processed:  Transcripts need NOT be Official).

Note:  To be accepted into the Communication Sciences Undergraduate Program, a student must have a GPA of 2.75 or better over the last 30 semester hours of academic work.  You must also complete an application for Undergraduate Admission (Texas Application) and submit it with Official Transcripts to the Admissions Office at ADM 105 (Clock Tower) or mail to P.O. Box 425679 Denton, TX 76204-3679.