CE Enrollment – The Four Stages of Imitation DVD (ASHA Course ABBL9011) If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required Please complete the form below to receive CEUs for your participation in the 1-hour self-study course, The Four Stages of Imitation. Once your information is submitted, you will receive a reply email from us in 4-8 weeks containing your certificate of completion. If you need us to rush your certificate of completion, please contact us. Thank you! PARTICIPANT INFORMATION ENROLLMENT PIN * Your pin is on the CE info card inside of your DVD case. (If you did not receive a CE info card with a PIN, please use the pin "VERIFY" and we will verify your purchase manually.) Where did you purchase your CE course? PamMarshalla.comSpeech Corner First Name * Last Name * Address 1 * Address 2 City * State or Province * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland & Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Québec Saskatchewan Yukon Zip / Post Code * Country * Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia And Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, The Democratic Republic Of The Cook Islands Costa Rica Cote D'Ivoire Croatia (Local Name: Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Timor-Leste (East Timor) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France France, Metropolitan French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard And Mc Donald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic Of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic Of Korea, Republic Of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia, Former Yugoslav Republic Of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States Of Moldova, Republic Of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Kitts And Nevis Saint Lucia Saint Vincent And The Grenadines Samoa San Marino Sao Tome And Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa South Georgia, South Sandwich Islands South Sudan Spain Sri Lanka St. Helena St. Pierre And Miquelon Sudan Suriname Svalbard And Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic Of Thailand Togo Tokelau Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis And Futuna Islands Western Sahara Yemen Yugoslavia Zambia Zimbabwe Phone * Email * Check here if you do NOT want ASHA CEUs for taking this course. If you do not want ASHA CEUs, please leave the "ASHA Account Number" field blank ASHA Account Number Only if you are NOT an ASHA member, please complete the field below which is most appropriate. If you are not an ASHA member or CCC holder, you must be licensed or credentialed to practice speech-language pathology (SLP) or audiology or preparing to practice to earn ASHA CEUs. LICENSED Enter your state and license number CERTIFIED Enter your state/organization name and number CLINICAL FELLOW Enter your supervisor name and his/her ASHA number STUDENT If you are enrolled in a graduate program in SLP or audiology, enter your university name and expected graduation date LEARNING ASSESSMENT Please feel free to reference your handout or the lecture while answering questions. The investigator who first identified the four stages of imitation was: * Please select... Peter Ladefoged Jean Piaget Noam Chomsky The goal of the first stage of imitation is to: * Please select... Imitate the therapist Imitate the parent Make any sound The second stage, called Mutual Imitation, is characterized by: * Please select... No turn-taking behavior Turn-taking initiated by the therapist Turn-taking initiated by the child The ability of the child to imitate the sounds he already can produce is called: * Please select... Spontaneous Imitation of Old Repertoire Spontaneous Imitation of New Repertoire Spontaneous Imitation of Recent Repertoire In the final stage, the child can imitate any novel sound or word. This emerges: * Please select... By 6 months of age Around the first birthday By 2 years of age PROGRAM EVALUATION Please rate the following statements from 1 to 5 using the guide below. 1 = Strongly Disagree 2 = Somewhat Disagree 3 = Unsure 4 = Mostly Agree 5 = Strongly Agree 1 - Strongly Disagree 2 - Somewhat Disagree 3 - Unsure 4 - Mostly Agree 5 - Strongly Agree The material in this recorded seminar was practical to speech-language therapy. 1 - Strongly Disagree 2 - Somewhat Disagree 3 - Unsure 4 - Mostly Agree 5 - Strongly Agree The material presented in the seminar was well-organized. 1 - Strongly Disagree 2 - Somewhat Disagree 3 - Unsure 4 - Mostly Agree 5 - Strongly Agree The speaker was knowledgeable about the subject matter. 1 - Strongly Disagree 2 - Somewhat Disagree 3 - Unsure 4 - Mostly Agree 5 - Strongly Agree The audio recording was of good quality and easy to hear. 1 - Strongly Disagree 2 - Somewhat Disagree 3 - Unsure 4 - Mostly Agree 5 - Strongly Agree The video recording was of good quality and easy to see. 1 - Strongly Disagree 2 - Somewhat Disagree 3 - Unsure 4 - Mostly Agree 5 - Strongly Agree The written material was easy to follow with the recording. 1 - Strongly Disagree 2 - Somewhat Disagree 3 - Unsure 4 - Mostly Agree 5 - Strongly Agree This seminar was consistent with advertised content. 1 - Strongly Disagree 2 - Somewhat Disagree 3 - Unsure 4 - Mostly Agree 5 - Strongly Agree The speaker was open about his/her financial and non-financial relationships; there was no apparent conflict of interest. 1 - Strongly Disagree 2 - Somewhat Disagree 3 - Unsure 4 - Mostly Agree 5 - Strongly Agree My overall experience with this seminar was positive. 1 - Strongly Disagree 2 - Somewhat Disagree 3 - Unsure 4 - Mostly Agree 5 - Strongly Agree I will be interested in additional recorded seminars from this speaker and company. Is there anything that you especially liked or disliked about this recorded seminar? Did you learn anything that you found exciting, new, or surprising? If so, will you tell us about it? Did you find anything challenging about the learning experience? If so, how could we have made it easier? Please use the space provided below to make comments on any of the items above or on any other aspect of your experience that you would like to bring to our attention.