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? 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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 LadefogedJean PiagetNoam Chomsky The goal of the first stage of imitation is to: * Please select...Imitate the therapistImitate the parentMake any sound The second stage, called Mutual Imitation, is characterized by: * Please select...No turn-taking behaviorTurn-taking initiated by the therapistTurn-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 RepertoireSpontaneous Imitation of New RepertoireSpontaneous 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 ageAround the first birthdayBy 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. 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