Clinic Applications & Forms

Applications for both children and adult clients may be submitted at any time, but please note that in most circumstances, therapy appointments will begin at the start of an academic semester (Fall, Spring, or Summer). Graduate and undergraduate students provide services under the supervision of licensed and certified speech-language pathologists and audiologists.

Please use the following forms to apply or refer for services at the KACCD. 
These documents require Adobe Reader. Once completed, please email the forms to Alternatively, you can also mail the completed forms to:

Kay Armstead Center for Communication Disorders
Dept of Communicative Disorders & Sciences
1 Washington Sq.
San Jose, CA 95192-0079

New Client Applications


 2020 Telepractice Applications


Spanish (Espanol)

Specialty Services

If interested in a specialty service, please complete a general application form above in addition to the applications below:


Accent Modification Services

Adult (18+ years) Accent Modification Services Application [PDF] 

Augmentative & Alternative Communication

AAC Assessment Clinic - Child Referral Form [PDF]

AAC Assessment Clinic - Adult Referral Form [PDF]

2020 Stuttering Summer Camp

 Enrolled Client Forms