Request Proof of Clinical Documentation

• U of A
• Communication Sciences and Disorders
• Bachelor of Science
• Request Proof of Clinical Documentation

Please use the form below to request documentation of the clinical observation and/or direct contact hours you performed while enrolled at the University of Arkansas.

Fields marked * are required.

If you see this don't fill out this input box.

*First Name

*Last Name (while at UA)

*Current Email

*UA Student ID Number

*Graduation Year

*Delivery Method

Please Select To my current email To school contact email To school's physical address To my physical address For pickup

*School/Organization Contact (First and Last Name)

School/Org Contact Email

School/Org Mailing Address

School/Org Mailing Address 2

School/Org City

School/Org State

School/Org Zip

School/Org Phone

*Documentation Type

Need signed letterNeed copies of hour logsMy school/org has specific form

Submit