SLPA-template SIR-H2 2026

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The document is a Statement of Intent to Register for the Speech Language Pathology Assistant (SLPA) Fieldwork Experience Program at CSU Northridge. It requires accepted students to confirm their intention to enroll by completing and returning the form within 5 days. The form includes options to accept or decline the offer, request disability accommodations, and provides instructions for submission.

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Click ‘Get Form’ to open the SLPA-template SIR-H2 in the editor.
Begin by checking the box next to 'I ACCEPT' if you intend to register for the upcoming cohort. This confirms your acceptance of admission.
If you require disability accommodations, check the corresponding box and ensure you contact CSUN’s Disability Resources & Educational Services (DRES) office as instructed.
If you choose to decline the offer, check the 'I DECLINE' box and provide a reason for your decision in the space provided.
Fill in your printed name, sign the document, and date it appropriately.
Once completed, return this form via email, fax, or mail as specified at the bottom of the document.

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