# # Flosp Mailing List request. # 


MAIL-TO hiltonjc@jmu.edu Mailing List |||name^20||| |||academic_level^20|||
+--------------------------------------------------+ 
|| Flosp Information Request form ||
|| from ||
|||NAME^50||| 
|| at ||
|||DATE^50||| 
+--------------------------------------------------+ 
SocialSecurity: |ssn|
Name: |name| 
Home Phone: |phonehome|
Work Phone: |phonework|
Address: |address| 
Email: |email|
Undergrad Institution: |institution|
GPA: |overall_gpa|
Undergrad Major: |major|
Major GPA: |gpa|
Baccalaureate Degree Obtained: |degree|
Employed by Public School: |employee|
SLP: |slp|
School System: |school_system|
License in VA: |licensed_in_VA|
Date Granted: |date_of_license|
Certificate: |bs_15| |bs_license| |no_unsure|

Provisional license: 
Completed six graduate hours: |6_hours|  
Accepted to grad school: |gradschool|
Passed Praxis tests: |Praxis|
Masters in SLP: |masters_deg|
Graduate Info: |grad_info|
GRE: |gre|

Score: 
V: |v|
Q: |q|
A: |a|

Have you applied to JMU's graduate program?: |have_applied_JMU|
Date Applied: |when|
Accepted: |unconditionally| |conditionally| |unsure| |no|
Accepted Conditionally, met requirements: |met_the_conditions|
Date for meeting conditions required: |when_you_will_meet_the_condition|
Written request for status change: |sent_status|
Completed 25 observation hours: |completed_25_observation_hours|
Supervised ASHA clock hours: |have_ASHA_clock_hours|
Number of ASHA hours: |total_hours|
Date and Place obtained: |when_and_where|
Prefer to take Classes: |evening| |summer| |weekends|
Greatest need as Part-time Grad: |need+|


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