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Register for the Oticon Educational Student Resource Network using the online form below.
Student Contact Information
First Name:
First Name: must have at least 0 and no more than 256 characters.
*
MI:
MI: must have at least 0 and no more than 256 characters.
Last Name:
Last Name: must have at least 0 and no more than 256 characters.
*
Gender:
Male
Female
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Present Address:
Present Address: must have at least 0 and no more than 256 characters.
*
City:
City: must have at least 0 and no more than 256 characters.
*
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Washington, D.C
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
Not US
*
Zip:
Zip: must have at least 0 and no more than 256 characters.
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Home Address:
Home Address: must have at least 0 and no more than 256 characters.
*
City (Home):
City (Home): must have at least 0 and no more than 256 characters.
*
State (Home):
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Washington, D.C
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
Not US
*
Zip (Home):
Zip (Home): must have at least 0 and no more than 256 characters.
*
Phone:
Enter a valid telephone number.
*
Cellphone:
Enter a valid telephone number.
Email (Personal):
Enter a valid email address.
*
Email (University):
Email (University): must have at least 0 and no more than 256 characters.
University Affiliation & Information
Au.D University / Institution:
Au.D University / Institution: must have at least 0 and no more than 256 characters.
*
Expected Graduation Date (MM/DD/YYYY):
Expected Graduation Date (MM/DD/YYYY): must have at least 0 and no more than 10 characters.
*
Have you done a clinical rotation in a clinic or private practice setting?
Yes
No
*
Have you had clinical experience with Oticon hearing devices?
Yes
No
*
Have you attended an Oticon Audiology Camp?
Yes
No
*
Would you like to attended an Oticon Audiology Camp?
Yes
No
*
Clinical Interest (check all that apply)
Assistive Listening Devices
Audiologic Diagnostic Assessments
Auditory Processing Assessment and Treatment
Aural Rehabilitation
Cochlear Implants
Electrophysiologic Testing
Implantable Hearing Aids
Hearing Aid Selection, Fitting and Management
Hearing Conservation
Industrial Testing
Intraoperative Monitoring
Pediatric Testing
Tinnitus Assessment and Treatment
Vestibular Assessments and Rehabilitation
Other:
Other: must have at least 0 and no more than 256 characters.
Preferred Professional Setting Post Graduation (check all that apply)
Clinic (non-profit)
ENT Practice
Hospital
Industrial Audiology Practice
K-12 School System
Manufacturer/Industry
Multi-Specialty Medical Practice
Private Audiology Practice
University (Clinician)
University (Faculty)
VA or Military Hospital/Clinic
Other:
Other: must have at least 0 and no more than 256 characters.
To what degree is Private Audiology Practice your planned futurepractice setting:
Definitely Yes
Maybe
Non-ownership
Very Likely
Ownership
*
Communication Disclosure
By registering for the Oticon Educational Student Resource Network, I agree to accept to receive electronic mail, postal mail and through other communications from Oticon:
*
Other
Yes, please mail me a FREE Starbucks $5.00 gift card for registering for the OticonUSA Student Network