Register * Please Select Your Industry*Speech-Language PathologyAudiology Type of Practice* -- Please Select --Private PracticeHealthEducationNon-PractisingWorking Out of ProvinceRetiredOther Username* Usernames cannot be changed. Password* Type your password. The password must have a minimum strength of StrongStrength indicator Contact Information First Name* Last Name* Home Address Street Address City Province -- Please Select --Newfoundland and LabradorPrince Edward IslandNova ScotiaNew BrunswickQuebecOntarioManitobaSaskatchewanAlbertaBritish ColumbiaYukon TerritoryNorthwest TerritoriesNunavutOutside of Canada Postal Code Home Phone* Required phone number format: (###) ###-#### Home Fax Required phone number format: (###) ###-#### Home Email Address Primary Work Address Street Address City Province -- Please Select --Newfoundland and LabradorPrince Edward IslandNova ScotiaNew BrunswickQuebecOntarioManitobaSaskatchewanAlbertaBritish ColumbiaYukon TerritoryNorthwest TerritoriesNunavutOutside of Canada Postal Code Work Phone Number* Required phone number format: (###) ###-#### Work Fax Required phone number format: (###) ###-#### Work Email Address* Is this your preferred method of contact?YesNoRegistration Information Registration Status* -- Please Select --RenewalRe-RegistrationInitial NB Registration - New GraduateInitial NB Registration (Previously Registered In Other Jurisdiction) Membership Status* --Please Select --Practising MemberNon-Practising MemberProvisional Member Registration Number Previous Province/Country of Residence (if applicable) -- Please Select --Newfoundland and LabradorPrince Edward IslandNova ScotiaNew BrunswickQuebecOntarioManitobaSaskatchewanAlbertaBritish ColumbiaYukon TerritoryNorthwest TerritoriesNunavutOutside of Canada Previous Province/Country of Employment (if applicable) -- Please Select --Newfoundland and LabradorPrince Edward IslandNova ScotiaNew BrunswickQuebecOntarioManitobaSaskatchewanAlbertaBritish ColumbiaYukon TerritoryNorthwest TerritoriesNunavutOutside of Canada Previous Province/Country of Registration (if applicable) -- Please Select --Newfoundland and LabradorPrince Edward IslandNova ScotiaNew BrunswickQuebecOntarioManitobaSaskatchewanAlbertaBritish ColumbiaYukon TerritoryNorthwest TerritoriesNunavutOutside of Canad Registration Number in Previous Jurisdiction SAC Member?YesNo SAC Certification?YesNo SAC Certification Number CEE Rotation Cycle ABC(As assigned by the SAC. If not a member of SAC, NBASLPA will assign) CAA CertificationYesNo CAA Number GenderMaleFemaleOther Year Of Birth ASHA CertificationYesNo ASHA Certification Number Language of Correspondence Preference *EnglishFrench Continuing Education Requirements (Jan-Dec) I am able to provide services in the following languages(s)Unilingual EnglishUnilingual FrenchFunctionally Bilingual (1st language English)Functionally Bilingual (1st language French)Fluently Bilingual (1st language English)Fluently Bilingual (1st language French)MigmacMaliseetPassamaquoddySign LanguageOther Specify Other Language Enter additional language(s)Audiology Education ONLYDiploma Diploma Level Achieved?YesNo Training Institute -- Please Select --Dalhousie UniversityMcGill UniversityUniversité de MontréalUniversité d'OttawaUniversity of Western OntarioUniversity of British ColumbiaUniversity of AlbertaUniversity of TorontoU.S.A.Other Other Training Institute 1 Graduation Year Province -- Please Select --Newfoundland and LabradorPrince Edward IslandNova ScotiaNew BrunswickQuebecOntarioManitobaSaskatchewanAlbertaBritish ColumbiaYukon TerritoryNorthwest TerritoriesNunavutOutside of Canada At/After Entry To Work ForceAt EntryAfter EntryBachelor Bachelor Level Achieved?YesNo Training Institute -- Please Select --Dalhousie UniversityMcGill UniversityUniversité de MontréalUniversité d'OttawaUniversity of Western OntarioUniversity of British ColumbiaUniversity of AlbertaUniversity of TorontoU.S.A.Other Other Training Institute 2 Graduation Year Province -- Please Select --Newfoundland and LabradorPrince Edward IslandNova ScotiaNew BrunswickQuebecOntarioManitobaSaskatchewanAlbertaBritish ColumbiaYukon TerritoryNorthwest TerritoriesNunavutOutside of Canada At/After Entry To Work ForceAt EntryAfter EntryMaster Master Level AchievedYesNo Training Institute -- Please Select --Dalhousie UniversityMcGill UniversityUniversité de MontréalUniversité d'OttawaUniversity of Western OntarioUniversity of British ColumbiaUniversity of AlbertaUniversity of TorontoU.S.A.Other Other Training Institute Graduation Year Province -- Please Select --Newfoundland and LabradorPrince Edward IslandNova ScotiaNew BrunswickQuebecOntarioManitobaSaskatchewanAlbertaBritish ColumbiaYukon TerritoryNorthwest TerritoriesNunavutOutside of Canada At/After Entry To Work ForceAt EntryAfter EntryPhD PhD Level Achieved?YesNo Training Institute -- Please Select --Dalhousie UniversityMcGill UniversityUniversité de MontréalUniversité d'OttawaUniversity of Western OntarioUniversity of British ColumbiaUniversity of AlbertaUniversity of TorontoU.S.A.Other Other Training Institution Graduation Year Province -- Please Select --Newfoundland and LabradorPrince Edward IslandNova ScotiaNew BrunswickQuebecOntarioManitobaSaskatchewanAlbertaBritish ColumbiaYukon TerritoryNorthwest TerritoriesNunavutOutside of Canada At/After Entry To Work ForceAt EntryAfter EntryMaster Master Level Achieved?YesNo Training Institution -- Please Select -Dalhousie UniversityMcGill UniversityUniversité de MontréalUniversité d'OttawaUniversity of Western OntarioUniversity of British ColumbiaUniversity of AlbertaUniversity of TorontoU.S.A.Other Graduation Year Province -- Please Select --Newfoundland and LabradorPrince Edward IslandNova ScotiaNew BrunswickQuebecOntarioManitobaSaskatchewanAlbertaBritish ColumbiaYukon TerritoryNorthwest TerritoriesNunavutOutside of Canada At/After Entry To Work ForceAt EntryAfter EntryPhD PhD Level AchievedYesNo Training Institution -- Please Select -Dalhousie UniversityMcGill UniversityUniversité de MontréalUniversité d'OttawaUniversity of Western OntarioUniversity of British ColumbiaUniversity of AlbertaUniversity of TorontoU.S.A.Other Graduation Year Province -- Please Select --Newfoundland and LabradorPrince Edward IslandNova ScotiaNew BrunswickQuebecOntarioManitobaSaskatchewanAlbertaBritish ColumbiaYukon TerritoryNorthwest TerritoriesNunavutOutside of Canada At/After Entry To Work ForceAt EntryAfter EntryOther Other Level Achieved YesNo Training Institution -- Please Select -Dalhousie UniversityMcGill UniversityUniversité de MontréalUniversité d'OttawaUniversity of Western OntarioUniversity of British ColumbiaUniversity of AlbertaUniversity of TorontoU.S.A.Other Graduation Year Province -- Please Select --Newfoundland and LabradorPrince Edward IslandNova ScotiaNew BrunswickQuebecOntarioManitobaSaskatchewanAlbertaBritish ColumbiaYukon TerritoryNorthwest TerritoriesNunavutOutside of Canada At/After Entry To Work ForceAt EntryAfter EntryOther Education ONLYOther Education - Item One Level -- Please Select --DiplomaBaccalaureateMasterPhD/Doctorate Discipline/Faculty 1 -- Please Select --ArtsScienceEducationBusiness AdministrationOther Other Discipline/Faculty Training Institution -- Please Select --Dalhousie UniversityMcGill UniversityUniversité de MontréalUniversité d'OttawaUniversity of Western OntarioUniversity of British ColumbiaUniversity of AlbertaUniversity of TorontoU.S.A.Other Graduation Year Province -- Please Select --Newfoundland and LabradorPrince Edward IslandNova ScotiaNew BrunswickQuebecOntarioManitobaSaskatchewanAlbertaBritish ColumbiaYukon TerritoryNorthwest TerritoriesNunavutOutside of Canada Other Education - Item Two Level -- Please Select --DiplomaBaccalaureateMasterPhD-Doctorate Discipline/Faculty 2 -- Please Select --ArtsScienceEducationBusiness AdministrationOther Other Discipline/Faculty Training Institution -- Please Select --Dalhousie UniversityMcGill UniversityUniversité de MontréalUniversité d'OttawaUniversity of Western OntarioUniversity of British ColumbiaUniversity of AlbertaUniversity of TorontoU.S.A.Other Graduation Year Province -- Please Select --Newfoundland and LabradorPrince Edward IslandNova ScotiaNew BrunswickQuebecOntarioManitobaSaskatchewanAlbertaBritish ColumbiaYukon TerritoryNorthwest TerritoriesNunavutOutside of Canada Other Education - Item Three Level -- Please Select --DiplomaBaccalaureateMasterPhD-Doctorate Discipline/Faculty 3 -- Please Select --ArtsScienceEducationBusiness AdministrationOther Other Discipline/Faculty 3 Training Institution -- Please Select --Dalhousie UniversityMcGill UniversityUniversité de MontréalUniversité d'OttawaUniversity of Western OntarioUniversity of British ColumbiaUniversity of AlbertaUniversity of TorontoU.S.A.Other Graduation Year Province -- Please Select --Newfoundland and LabradorPrince Edward IslandNova ScotiaNew BrunswickQuebecOntarioManitobaSaskatchewanAlbertaBritish ColumbiaYukon TerritoryNorthwest TerritoriesNunavutOutside of Canada Other Education - Item Four Level -- Please Select --DiplomaBaccalaureateMasterPhD-Doctorate Discipline/Faculty 4 -- Please Select --ArtsScienceEducationBusiness AdministrationOther Other Discipline/Faculty 4 Training Institution -- Please Select --Dalhousie UniversityMcGill UniversityUniversité de MontréalUniversité d'OttawaUniversity of Western OntarioUniversity of British ColumbiaUniversity of AlbertaUniversity of TorontoU.S.A.Other Graduation Year Province -- Please Select --Newfoundland and LabradorPrince Edward IslandNova ScotiaNew BrunswickQuebecOntarioManitobaSaskatchewanAlbertaBritish ColumbiaYukon TerritoryNorthwest TerritoriesNunavutOutside of Canada Continuing Competency ProfileCertifications and Specialization - Item One Area Of Education 1 -- Please Select --Adult Neurological DisordersArticulation/PhonologyAugmentative CommunicationAural RehabilitationAutism/Pervasive Developmental DisorderCentral Auditory ProcessingChild Language DisordersCleft Lip/PalateComputer ApplicationsDevelopmental ApraxiaDysphagiaEducational ServicesGeriatric Communication DisordersHearing ImpairmentHead InjuryLaryngectomyLearning DisabilitiesParent/Caregiver TrainingPrevention/PromotionPsychiatric DisordersResearchStudent SupervisionStutteringVoice/Resonance DisordersOther Area Of Education 1 -- Please Select --Aural RehabilitationCentral Auditory TestingCochlear ImplantsCounsellingComputer ApplicationsEducational ServicesElectro-physiological TestingEvaluationGeriatricsHearing Aids/Assistive DevicesIndustrial AudiologyOtoacoustic EmissionsParent/Caregiver TrainingResearchStudent SupervisionPediatricsOthe Other Area Of Education 1 Hours Province -- Please Select --Newfoundland and LabradorPrince Edward IslandNova ScotiaNew BrunswickQuebecOntarioManitobaSaskatchewanAlbertaBritish ColumbiaYukon TerritoryNorthwest TerritoriesNunavutOutside of Canada Year of Graduation/Completion Area Of Experience 1 -- Please Select --AphasiaApraxiaArticulation/PhonologyAugmentative CommunicationAural RehabilitationAutismCentral Auditory ProcessingChild Language DisorderCleft Lip/PalateCognitive ImpairmentComputer ApplicationsDementiaDiagnostic OnlyDysphagiaEducational ServicesGerontolgoyHearing ImpairmentLanguage of ConfusionLaryngectomyLearning DisabilityParent/Caregiver TrainingPrevention/PromotionPsychiatric DisordersResearchStudent SupervisionStutteringVoice/Resonance ProblemsOther Area Of Experience 1 -- Please Select --Aural RehabilitationCentral Auditory TestingCochlear ImplantsCounsellingComputer ApplicationsEducational ServicesElectro-physiological TestingEvaluationGeriatricsHearing Aids/Assistive DevicesIndustrial AudiologyOtoacoustic EmissionsParent/Caregiver TrainingResearchStudent SupervisionPediatricsOther Other Area Of Experience 1 Area Of Special Interest 1 -- Please Select --AphasiaApraxiaArticulation/PhonologyAugmentative CommunicationAural RehabilitationAutismCentral Auditory ProcessingDevelopmental Language DisorderCleft Lip/PalateCognitive ImpairmentComputer ApplicationsDementiaDiagnostic OnlyDysphagiaEducational ServicesGerontolgoyHearing ImpairmentLanguage of ConfusionLaryngectomyLearning DisabilityParent/Caregiver TrainingPrevention/PromotionPsychiatric DisordersResearchStudent SupervisionStutteringVoice/Resonance ProblemsOther Area Of Special Interest 1 -- Please Select --Aural RehabilitationCentral Auditory TestingCochlear ImplantsCounsellingComputer ApplicationsEducational ServicesElectro-physiological TestingEvaluationGeriatricsHearing Aids/Assistive DevicesIndustrial AudiologyOtoacoustic EmissionsParent/Caregiver TrainingResearchStudent SupervisionPediatricsOther Certifications and Specialization - Item Two Area Of Education 2 -- Please Select --Adult Neurological DisordersArticulation/PhonologyAugmentative CommunicationAural RehabilitationAutism/Pervasive Developmental DisorderCentral Auditory ProcessingChild Language DisordersCleft Lip/PalateComputer ApplicationsDevelopmental ApraxiaDysphagiaEducational ServicesGeriatric Communication DisordersHearing ImpairmentHead InjuryLaryngectomyLearning DisabilitiesParent/Caregiver TrainingPrevention/PromotionPsychiatric DisordersResearchStudent SupervisionStutteringVoice/Resonance DisordersOther Area Of Education 2 -- Please Select --Aural RehabilitationCentral Auditory TestingCochlear ImplantsCounsellingComputer ApplicationsEducational ServicesElectro-physiological TestingEvaluationGeriatricsHearing Aids/Assistive DevicesIndustrial AudiologyOtoacoustic EmissionsParent/Caregiver TrainingResearchStudent SupervisionPediatricsOther Other Area Of Education 2 Hours Province -- Please Select --Newfoundland and LabradorPrince Edward IslandNova ScotiaNew BrunswickQuebecOntarioManitobaSaskatchewanAlbertaBritish ColumbiaYukon TerritoryNorthwest TerritoriesNunavutOutside of Canada Year of Graduation/Completion Area Of Experience 2 -- Please Select --AphasiaApraxiaArticulation/PhonologyAugmentative CommunicationAural RehabilitationAutismCentral Auditory ProcessingChild Language DisorderCleft Lip/PalateCognitive ImpairmentComputer ApplicationsDementiaDiagnostic OnlyDysphagiaEducational ServicesGerontolgoyHearing ImpairmentLanguage of ConfusionLaryngectomyLearning DisabilityParent/Caregiver TrainingPrevention/PromotionPsychiatric DisordersResearchStudent SupervisionStutteringVoice/Resonance ProblemsOther Area Of Experience 2 -- Please Select --Aural RehabilitationCentral Auditory TestingCochlear ImplantsCounsellingComputer ApplicationsEducational ServicesElectro-physiological TestingEvaluationGeriatricsHearing Aids/Assistive DevicesIndustrial AudiologyOtoacoustic EmissionsParent/Caregiver TrainingResearchStudent SupervisionPediatricsOther Other Area Of Experience 2 Area Of Special Interest 2 -- Please Select --AphasiaApraxiaArticulation/PhonologyAugmentative CommunicationAural RehabilitationAutismCentral Auditory ProcessingDevelopmental Language DisorderCleft Lip/PalateCognitive ImpairmentComputer ApplicationsDementiaDiagnostic OnlyDysphagiaEducational ServicesGerontolgoyHearing ImpairmentLanguage of ConfusionLaryngectomyLearning DisabilityParent/Caregiver TrainingPrevention/PromotionPsychiatric DisordersResearchStudent SupervisionStutteringVoice/Resonance ProblemsOther Area Of Special Interest 2 -- Please Select --Aural RehabilitationCentral Auditory TestingCochlear ImplantsCounsellingComputer ApplicationsEducational ServicesElectro-physiological TestingEvaluationGeriatricsHearing Aids/Assistive DevicesIndustrial AudiologyOtoacoustic EmissionsParent/Caregiver TrainingResearchStudent SupervisionPediatricsOther Certifications and Specialization - Item Three Area Of Education 3 -- Please Select --Adult Neurological DisordersArticulation/PhonologyAugmentative CommunicationAural RehabilitationAutism/Pervasive Developmental DisorderCentral Auditory ProcessingChild Language DisordersCleft Lip/PalateComputer ApplicationsDevelopmental ApraxiaDysphagiaEducational ServicesGeriatric Communication DisordersHearing ImpairmentHead InjuryLaryngectomyLearning DisabilitiesParent/Caregiver TrainingPrevention/PromotionPsychiatric DisordersResearchStudent SupervisionStutteringVoice/Resonance DisordersOther Area Of Education 3 -- Please Select --Aural RehabilitationCentral Auditory TestingCochlear ImplantsCounsellingComputer ApplicationsEducational ServicesElectro-physiological TestingEvaluationGeriatricsHearing Aids/Assistive DevicesIndustrial AudiologyOtoacoustic EmissionsParent/Caregiver TrainingResearchStudent SupervisionPediatricsOther Other Area Of Education 3 Hours Province -- Please Select --Newfoundland and LabradorPrince Edward IslandNova ScotiaNew BrunswickQuebecOntarioManitobaSaskatchewanAlbertaBritish ColumbiaYukon TerritoryNorthwest TerritoriesNunavutOutside of Canada Year of Graduation/Completion Area Of Experience 3 -- Please Select --AphasiaApraxiaArticulation/PhonologyAugmentative CommunicationAural RehabilitationAutismCentral Auditory ProcessingChild Language DisorderCleft Lip/PalateCognitive ImpairmentComputer ApplicationsDementiaDiagnostic OnlyDysphagiaEducational ServicesGerontolgoyHearing ImpairmentLanguage of ConfusionLaryngectomyLearning DisabilityParent/Caregiver TrainingPrevention/PromotionPsychiatric DisordersResearchStudent SupervisionStutteringVoice/Resonance ProblemsOther Area Of Experience 3 -- Please Select --Aural RehabilitationCentral Auditory TestingCochlear ImplantsCounsellingComputer ApplicationsEducational ServicesElectro-physiological TestingEvaluationGeriatricsHearing Aids/Assistive DevicesIndustrial AudiologyOtoacoustic EmissionsParent/Caregiver TrainingResearchStudent SupervisionPediatricsOther Other Area Of Experience 3 Area Of Special Interest 3 -- Please Select --AphasiaApraxiaArticulation/PhonologyAugmentative CommunicationAural RehabilitationAutismCentral Auditory ProcessingDevelopmental Language DisorderCleft Lip/PalateCognitive ImpairmentComputer ApplicationsDementiaDiagnostic OnlyDysphagiaEducational ServicesGerontolgoyHearing ImpairmentLanguage of ConfusionLaryngectomyLearning DisabilityParent/Caregiver TrainingPrevention/PromotionPsychiatric DisordersResearchStudent SupervisionStutteringVoice/Resonance ProblemsOther Area Of Special Interest 3 -- Please Select --Aural RehabilitationCentral Auditory TestingCochlear ImplantsCounsellingComputer ApplicationsEducational ServicesElectro-physiological TestingEvaluationGeriatricsHearing Aids/Assistive DevicesIndustrial AudiologyOtoacoustic EmissionsParent/Caregiver TrainingResearchStudent SupervisionPediatricsOther Total number of years employed in your field* Total number of years employed in your field in NB* If not employed in your field, are you seeking employment?YN Professional Liability Insurance -- Please Select --PersonalEmployerBothNone Current Employment Situation -- Please Select --EmployedNot EmployedLooking for another job in another professionWorking in another professionSeeking refresher courseFurthering education in professionRetired Employment Profile As Of Date Of RegistrationEmployment 1 Employed in SLP or Audiology?YesNo Employment Type -- Please Select --Full-time by ChoiceFull-time seeking Part-timePart-timePart-time seeking Full-timeTemporaryTemporary Full-timeTemporary Part-timeCasualCasual by ChoiceCasual Seeking Part-timeCasual Seeking Full-timeLeave of AbsenceLeave of Absence (LOA)Parental LeaveSick LeaveLong Term Disability Year Month -- Please Select--JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Employer Name Employer Code Other Education ONLY → Recherche pour code de l’employeur City/Town Postal Code Province -- Please Select --Newfoundland and LabradorPrince Edward IslandNova ScotiaNew BrunswickQuebecOntarioManitobaSaskatchewanAlbertaBritish ColumbiaYukon TerritoryNorthwest TerritoriesNunavutOutside of Canada Employment 1 Role 1 Role 1 -- Please Select --ClinicianAdministratorEducatorConsultantResearcherOther Select the role which best applies to you. Service Location 1 -- Please Select --School(s)Daycare(s)/Preschool(s)Hospital(s)Community Health Centre(s)Stan Cassidy Centre for RehabilitationProvincial Psychiatric FacilityClient's Home/ResidenceNursing Home(s)Mental Health Centre(s)Client's WorkplacePrivate Office/Company/ClinicCommunity Agency OfficeWorkers' Rehabilitation CentreUniversity/CollegeProvincial Government OfficeCommunity: Many LocationsOther Choose the code which best describes the place where your services are usually provided. Client Base 1 -- Please Select --Mixed (equal proportion each age group)Infants/Preschool Age ChildrenSchool Age ChildrenAdultsSeniorsMixed Population - 50% infants/preschoolMixed Population - 50% school ageMixed Population - 50% adultsMixed Population - 50% seniors50% infants/preschool - 50% school age50% adults - 50% seniorsNot Applicable Choose your primary client group. Language Of Service 1 -- Please Select --EnglishFrenchFrench and EnglishMigmacMaliseetPassamaquoddySign LanguageOther Average Paid Hours Per Week Support Personnel Hours Per Week (If Applicable) Employment 1 Role 2 Role 2 -- Please Select --ClinicianAdministratorEducatorConsultantResearcherOther Service Location 2 -- Please Select --School(s)Daycare(s)/Preschool(s)Hospital(s)Community Health Centre(s)Stan Cassidy Centre for RehabilitationProvincial Psychiatric FacilityClient's Home/ResidenceNursing Home(s)Mental Health Centre(s)Client's WorkplacePrivate Office/Company/ClinicCommunity Agency OfficeWorkers' Rehabilitation CentreUniversity/CollegeProvincial Government OfficeCommunity - Many LocationsOther Client Base 2 -- Please Select --Mixed (equal proportion each age group)Infants/Preschool Age ChildrenSchool Age ChildrenAdultsSeniorsMixed Population - 50% infants/preschoolMixed Population - 50% school ageMixed Population - 50% adultsMixed Population - 50% seniors50% infants/preschool - 50% school age50% adults - 50% seniorsNot Applicable Language Of Service 2 -- Please Select --EnglishFrenchFrench and EnglishMigmacMaliseetPassamaquoddySign LanguageOther Average Paid Hours Per Week Support Personnel Hours Per Week (If Applicable) Number Employment 1 Role 3 Role 3 -- Please Select --ClinicianAdministratorEducatorConsultantResearcherOther Service Location 3 -- Please Select --School(s)Daycare(s)/Preschool(s)Hospital(s)Community Health Centre(s)Stan Cassidy Centre for RehabilitationProvincial Psychiatric FacilityClient's Home/ResidenceNursing Home(s)Mental Health Centre(s)Client's WorkplacePrivate Office/Company/ClinicCommunity Agency OfficeWorkers' Rehabilitation CentreUniversity/CollegeProvincial Government OfficeCommunity - Many LocationsOther Client Base 3 -- Please Select --Mixed (equal proportion each age group)Infants/Preschool Age ChildrenSchool Age ChildrenAdultsSeniorsMixed Population - 50% infants/preschoolMixed Population - 50% school ageMixed Population - 50% adultsMixed Population - 50% seniors50% infants/preschool - 50% school age50% adults - 50% seniorsNot Applicable Language Of Service 3 -- Please Select --EnglishFrenchFrench and EnglishMigmacMaliseetPassamaquoddySign LanguageOther Average Paid Hours Per Week Support Personnel Hours Per Week (If Applicable) Employment 2 Employed in SLP or Audiology?YesNo Employment Type -- Please Select --Full-time by ChoiceFull-time seeking Part-timePart-timePart-time seeking Full-timeTemporaryTemporary Full-timeTemporary Part-timeCasualCasual by ChoiceCasual Seeking Part-timeCasual Seeking Full-timeLeave of AbsenceLeave of Absence (LOA)Parental LeaveSick LeaveLong Term Disability Year Month -- Please Select--JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Employer Name Employer Code → Recherche pour code de l’employeur City/Town Postal Code Province -- Please Select --Newfoundland and LabradorPrince Edward IslandNova ScotiaNew BrunswickQuebecOntarioManitobaSaskatchewanAlbertaBritish ColumbiaYukon TerritoryNorthwest TerritoriesNunavutOutside of Canada Employment 2 Role 1 Role 1 -- Please Select --ClinicianAdministratorEducatorConsultantResearcherOther Service Location 1 -- Please Select --School(s)Daycare(s)/Preschool(s)Hospital(s)Community Health Centre(s)Stan Cassidy Centre for RehabilitationProvincial Psychiatric FacilityClient's Home/ResidenceNursing Home(s)Mental Health Centre(s)Client's WorkplacePrivate Office/Company/ClinicCommunity Agency OfficeWorkers' Rehabilitation CentreUniversity/CollegeProvincial Government OfficeCommunity - Many LocationsOther Client Base 1 -- Please Select --Mixed (equal proportion each age group)Infants/Preschool Age ChildrenSchool Age ChildrenAdultsSeniorsMixed Population - 50% infants/preschoolMixed Population - 50% school ageMixed Population - 50% adultsMixed Population - 50% seniors50% infants/preschool - 50% school age50% adults - 50% seniorsNot Applicable Language Of Service 1 -- Please Select --EnglishFrenchFrench and EnglishMigmacMaliseetPassamaquoddySign LanguageOther Average Paid Hours Per Week Support Personnel Hours Per Week (If Applicable) Employment 2 Role 2 Role 2 -- Please Select --ClinicianAdministratorEducatorConsultantResearcherOther Service Location 2 -- Please Select --School(s)Daycare(s)/Preschool(s)Hospital(s)Community Health Centre(s)Stan Cassidy Centre for RehabilitationProvincial Psychiatric FacilityClient's Home/ResidenceNursing Home(s)Mental Health Centre(s)Client's WorkplacePrivate Office/Company/ClinicCommunity Agency OfficeWorkers' Rehabilitation CentreUniversity/CollegeProvincial Government OfficeCommunity - Many LocationsOther Client Base 2 -- Please Select --Mixed (equal proportion each age group)Infants/Preschool Age ChildrenSchool Age ChildrenAdultsSeniorsMixed Population - 50% infants/preschoolMixed Population - 50% school ageMixed Population - 50% adultsMixed Population - 50% seniors50% infants/preschool - 50% school age50% adults - 50% seniorsNot Applicable Language Of Service 2 -- Please Select --EnglishFrenchFrench and EnglishMigmacMaliseetPassamaquoddySign LanguageOther Average Paid Hours Per Week Support Personnel Hours Per Week (If Applicable) Number Employment 2 Role 3 Role 3 -- Please Select --ClinicianAdministratorEducatorConsultantResearcherOther Service Location 3 -- Please Select --School(s)Daycare(s)/Preschool(s)Hospital(s)Community Health Centre(s)Stan Cassidy Centre for RehabilitationProvincial Psychiatric FacilityClient's Home/ResidenceNursing Home(s)Mental Health Centre(s)Client's WorkplacePrivate Office/Company/ClinicCommunity Agency OfficeWorkers' Rehabilitation CentreUniversity/CollegeProvincial Government OfficeCommunity - Many LocationsOther Client Base 3 -- Please Select --Mixed (equal proportion each age group)Infants/Preschool Age ChildrenSchool Age ChildrenAdultsSeniorsMixed Population - 50% infants/preschoolMixed Population - 50% school ageMixed Population - 50% adultsMixed Population - 50% seniors50% infants/preschool - 50% school age50% adults - 50% seniorsNot Applicable Language Of Service 3 -- Please Select --EnglishFrenchFrench and EnglishMigmacMaliseetPassamaquoddySign LanguageOther Average Paid Hours Per Week Support Personnel Hours Per Week (If Applicable) Registration Year* → Search for Employer Code → Search for Employer CodeArea Of ExperienceArea Of Special InterestSpeech Language Pathology Education ONLY → Search for Employer Code → Search for Employer CodeSend these credentials via email.
