Open Enrollment for Wood County Speech Program

    First Name
    Last Name
    Student age
    Please provide the student's grade at the time of submission.
    Please list each diagnosis to appropriately match youth with correct services.
    Does the student work well in a group setting? NoYes
    Parent or Guardian Name
    Country
    Address Line 1
    Address Line 2
    City
    State
    Zip Code
    Phone
    Email
    Referring Speech Pathologist
    Referring school, agency, or medical professional
    Please indicate which program you are referring to: Wood County Society Summer Speech (6 weeks)Wood County Society Speech Program (Begins Summer / Fall 2024)