Get Aphasia Institute Application - The Vegas Voice Institute

Completing the Aphasia Institute Application for The Vegas Voice Institute is an essential step towards participating in an intensive program designed to support individuals with aphasia. This guide provides detailed instructions to ensure a smooth and efficient application process.

Follow the steps to complete the application effectively.

1. Click 'Get Form' button to access the application form and open it in your preferred document editor.
2. Begin filling out the form by providing your name, street address, city, state, zip code, home phone number, cell phone number, email address, date of birth, age, and gender.
3. Indicate if you have previously applied to this program. Additionally, fill in your preferred dates of attendance along with the name and email of the person completing this form.
4. Provide caregiver information, including the caregiver's name, relationship to the applicant, phone number, marital status, spouse's occupation, phone number, email, and spouse's name.
5. Describe language skills by indicating specific tasks you find challenging and check the appropriate boxes regarding your speaking and reading abilities.
6. Include detailed information regarding your medical history, nature of illness or accident, previous facilities treated, and include a copy of your medical records from your physician, speech-language pathologist, and hospital.
7. Complete the Acknowledgement section by understanding the financial responsibilities and signing off with your name, date, and signature.
8. Once all information is complete and reviewed, save your changes and either download, print, or share the application as needed. Finally, email it to vegasvoice@LVcoxmail.com.

Start completing your application online today to secure your spot in the program.