University of Michigan Aphasia Program (UMAP)

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University Center for the Development of the Language and Literacy (UCLL)
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Admissions Considerations

The University of Michigan Aphasia Program (UMAP) is open to adults 16 and over with all types of aphasia and all levels of impairment. Clients enrolled without a caregiver must be independent in mobility and self-care.

The University of Michigan, as an equal opportunity/affirmative action employer, complies with all applicable federal and state laws regarding nondiscrimination and affirmative action, including Title IX of the Education Amendments of 1972 and Section 504 of the Rehabilitation Act of 1973. The University of Michigan is committed to a policy of nondiscrimination and equal opportunity for all persons regardless of race, sex*, color, religion, creed, national origin or ancestry, age, marital status, sexual orientation, disability, or Vietnam-era veteran status in employment, educational programs and activities, and admissions. Inquiries or complaints may be addressed to the Senior Director for Institutional Equity and Title IX/Section 504 Coordinator, Office for Institutional Equity, 2072 Administrative Services Building, Ann Arbor, Michigan 48109-1432, 734.763.0235, TTY 734.647.1388. For other University of Michigan information call 734.764.1817.
*Includes discrimination based on gender identity and gender expression.

If you have questions about the application process or if you would like to schedule a tour of the Center, please contact our Clinical Services Manager, Ms. Mimi Block, at 734.764.8440. The information gathered on the following forms will help our staff determine suitability to the program.

Admission Procedure

Complete and submit the following application. All information will be considered confidential and is protected by Health Insurance Portability and Accountability Act of 1996 (HIPAA). Admission is contingent upon the receipt of your application. Have your physician complete the Medical Information Form and fax or mail it to UCLL.

When your application is received by the Center, records of hospitalization and rehabilitation services will be requested from the information you provide in your application. If you have copies of these records, forward them along with your application to expedite the application process.

The Clinical Services Manager will review the submitted information and determine the candidate’s appropriateness for enrollment in UMAP.

Invitations are extended only after receipt and review of the completed application.

The business office at UCLL can answer financial questions.

Enrollment is provided on a first-come-first-served basis in response to the invitation.

Identifying Information

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Other Information



First
Middle Initial
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Email address for the person completing this application.
Referral Info

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Referring party's email address

Caregiver Information


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Personal & Family History


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Language Skills

It is helpful to understand as much as possible about your communication abilities prior to attending the program. This information allows us to prepare your treatment program.


Please check all that apply:















Medical History






We would like to gather as much information as possible about your condition. Please identify each treatment facility you have attended. Please specify acute care hospital, rehabilitation hospital or other.

Previous Facility




Add a Facility

Personal Needs

















Personal Interests

Knowing your interests helps us to plan your therapy. It does not bare on our decision to accept you into the program.





Please list your family members, their respective ages & their relationship to you
Name Age Relationship
Add Family Member

History of Other Services

As we are planning treatment, it is helpful to have as much information as possible about the other services you have received.

Previous Service
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Add another service

Educational History


















Employment History




Medical Information Form

Please download and print the following Medical Information Form. It should be filled out by the applicant's physician.

When completed, it may be either mailed to:

University Center for the Development of Language and Literacy
1111 East Catherine Street
Ann Arbor, MI 48109-2054

Or it can be faxed to us at: (734) 647-2489

Medical Information Form

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