UofT SLP Document Release Request Form

COMPLETION OF THIS DOCUMENT IS REQUIRED IN ORDER FOR THE DEPARTMENT OF SPEECH-LANGUAGE PATHOLOGY TO RELEASE SUMMARY OF CLINICAL HOURS FORMS ON YOUR BEHALF. AN ADMINISTRATIVE FEE AS INDICATED BELOW APPLIES FOR EACH RELEASE REQUEST.

Please note that currently (as of 2020) if you are registering with SAC or CASLPO individuals are NOT required to provide proof of hours.

Full Name*
First Last
Name at time of Graduation (If different than above)
Year of Graduation*
Student Number
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
I require the department to release my hours to:*
- Bodies Outside Ontario (the SLP program form)
- Bodies Outside Ontario (their form)
- Self
- Multi-Page Evidence and Summary Hours Form
Send the SLP Summary of Clinical Practice Hours form to:
Include the organization name and email address.
Bodies Outside Ontario (the SLP program form)
Price: $ 12.00 CAD
Send the Agency Summary of Clinical Practice Hours form to:
Include the organization name and email address. Students will submit the pre-filled form as required by the agency under separate cover to slp.clinicalaffairs@utoronto.ca for verification and signature. Students will include a report of any variance from the form required by the UofT SLP program.
Bodies Outside Ontario (their form)
Price: $ 12.00 CAD
Email (if different from above)
Self
Price: $ 12.00 CAD
Multi-Page Evidence and Summary Hours Form.
Include the organization name and submission requirements (mail, email etc). Students will submit the pre-filled package of documents as required by the agency under separate cover to slp.clinicalaffairs@utoronto.ca for verification and signatures. Students will include a report along with the hours documentation of any variance from the form required by the UofT SLP program.
Multi-Page Evidence and Summary Hours Form
Price: $ 30.00 CAD
Total
$ 0.00 CAD
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