Baker Scholars Program Registration Form

The Baker Scholars Program supports families who have limited access to listening and spoken language intervention services. It is operated by the Baker Institute for Children with Hearing Loss in collaboration with the Stanford Ear Institute. The Baker Scholars Program delivers parent coaching and direct therapy services so that children with cochlear implants can learn to listen and speak, regardless of the family's geographic proximity to appropriate services.


Parents are key participants in this process. To achieve the combined family and Baker Scholars Program goals for your child to reach his or her maximum potential in the areas of listening and spoken language development, your family must commit considerable time and effort to attending therapeutic sessions weekly and daily practice of the weekly therapeutic skills taught with your child. A parent or guardian must be present and participating in all sessions alongside your child.


This program is supplemental to any other educational and therapeutic services your child may already be receiving or may be eligible to receive in the future.


Please upload the following documents:

  1. Copy of your child’s most recent hearing test results (aided audiograms preferred)
  2. Copy of IEP (Individual Education Plan)
  3. Copy of any other current related reports
 

Your child

 
 
 
 
mm/dd/yyyy
 
 

 

Parents

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

Hearing loss

 
 
 
mm/dd/yyyy
 

 

Please describe your child's hearing

 

Right ear

 
 
 
 
 
mm/dd/yyyy
 

 

Left ear

 
 
 
 
 
mm/dd/yyyy
 

 

Technology access

 
 
 
 

 

Service providers working with you and your child

Where does your child receive audiology/ medical services for his/her hearing aid or cochlear implant?

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Please upload the following documents, if you have access to them:

1. Your child’s most recent hearing test results (aided audiograms preferred)

2. Most recent IEP (Individual Education Plan)

3. Any other current related reports

Drop your files here