Childhood Apraxia of Speech Directory - Info Form
In order to connect parents, clinicians, and others with clinicians who are knowledgeable about DTTC treatment for CAS, we have developed a directory of speech language pathologists who have attended one of Dr. Strand, Dr. Grigos, or Dr. Case's advanced workshops on the ChildApraxiaTreatment.org website. If you are interested in being listed on this directory, please fill out this form (if applicable to your work setting).

Please note: You do not have to include a full business address if you do not wish to, but please include AT LEAST city/state/zip. Our directory requires users to search by location (rather than name or business name), so if you do not include your city/state/zip, then users will not be able to locate you.
Sign in to Google to save your progress. Learn more
First Name
Last Name
Credentials/ Title *
Work setting (e.g. public school, private practice, outpatient clinic):
Business name: *
Business address:
Business City: *
Business State: *
Business Zip Code: *
Phone number:
Email address:
Business website (if applicable):
Age range treated:
Are you willing to mentor/collaborate with other professionals?
Clear selection
Do you accept referrals?
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy