Student Forms

These forms are used for both on-campus clinical practice and internships.  

Undergraduate students are responsible for retaining their observation and clinical clock hour forms for their personal files.  

    Clinical Clock Hours Tracking

    As you move through the program, you will gain clock hour experiences that collectively satisfy ASHA, California License, and California Credential requirements. To help you keep track of these hours, we have created a Clock Hours Tracking Spreadsheet for you to download and use . When you enter your clock hours in blue cells of the spreadsheet, they are automatically tallied and compared against the requirements you are expected to meet. In most cases, you will require the majority of your clinical clock hours across the following contexts: a) your on-campus clinics (typically 80-100 hours total), b) school & medical internships (typically 250+ hours total), c) observations hours (25 hours), d) audiometry (up to 10 hours). To learn more about clinical clock hours, please see the Advising Manual for Graduate Students

    "Long" and "Short" Knowledge And Skills Acquisition (KASA) Forms 

    Students keep track of their attainment of ASHA standards throughout the program using the "long" Knowledge and Skills Acquisition (KASA) form.  It can be found in your department-assigned secure Box folder, in your Roadmap document - scroll past your course roadmap and you will see it.  It summarizes a student's acquisition of the knowledge and skills delineated in the Standards for the Certificate of Clinical Competence (CCC). Entries are made only upon acquisition of the knowledge or skill; thus the KASA is not an evaluation, but rather a record that a particular knowledge or skill has been acquired. 

    The program also uses a "short" KASA form that clinical supervisors use to assess your clinical skills at the end of the semester. For more information about the KASA, please see the Advising Manual for Graduate Students in Speech, Language and Hearing Sciences

    Note: The following PDFs are in the process of being made full accessible. If you have difficulty reading the PDFs, please contact the SLHS Department at or (415) 338-1001.

    For PDF files, you'll need Adobe Acrobat 5.0 or above to view it. If you need Adobe Acrobat Reader it's available free from Adobe.