Wisconsin Speech-Language Pathology and Audiology Association

WSHA
702 Eisenhower Drive
Suite A
Kimberly, WI 54136
(800) 545-0640
FAX (920) 882-3655
wsha@wisha.org

Judy Kulpa Scholarship

Application Form:
First Name :
Last Name:
Address:
City:
State:
Zip Code:
Home Phone:
Email:
University:

Certification by Chairperson of the graduate program:
Name and Title of Chairperson:
Contact Phone:

Responses to the following questions will be rated together with the recommendations and grade point average to determine which applicant has excelled in clinical, academic and professional activities.

1. What are your plans for a career in Speech-Language Pathology?


2. What strengths do you bring to your intended profession?


3. Describe the role business plays in our profession.


4. Why should you be selected to receive this scholarship?


5. What professional/community service contributions have you made as a student (e.g., WSHA, NSSLHA, volunteer programs) and/or what leadership positions have you held?


Please be certain to mail the two letters of recommendation and the official transcript of graduate coursework after submitting this application. If there are questions, contact the WSHA Foundation at CSEasterling@aol.com. All materials must be received at the WSHA Foundation office on or before June 23, 2012. Incomplete or late applications will be disqualified. Mailing Address: Wisconsin Speech-Language-Hearing Association Foundation 344 Evergreen Lane Pewaukee, WI 53072

702 Eisenhower Drive, Suite A, Kimberly, WI 54136 | FAX (920) 882-3655 | (800) 545-0640 | wsha@wisha.org