Speech Language Screening Form
Virginia Department of Education 10/3/2005 1 S PEECH -L ANGUAGE S CREENING F ORM This screening instrument is designed for the classroom teacher to administer.
INSTRUCTIONS FOR SPEECH OR LANGUAGE SCREENING . PRIOR TO EVALUATION. Students may be screened for articulation, fluency, voice, or language concerns prior to consideration for referral to special education.
Speech Evaluation Form Eastwood Christian School is offering the private services of a Certified Speech-Language Pathologist. Janice Griffin MS, CCC-SLP, who has 16 years experience in the field of Speech- Language pathology will be providing you with the opportunity for a Screening Test for ...
NOTICE OF INTENT TO SUBMIT (FORM V) Dear Prospective Vendor: RE: RFP #09-17 for Speech Screening, Speech Therapy, and Speech-Language Evaluation Services. To keep our mailing lists current and avoid the wasteful mailing of Public Bids to disinterested parties, a reply to this form is requested.
Microsoft Word - Speech Screening Form.doc. (Revised 8/96) SPEECH/LANGUAGE SERVICES SCREENING FORM DUE DATE: Please return this form to: Student: Building: Grade: D.O.B.: Teacher: Language Screening Procedure:_____ _____Pass _____Fail Comments ...
The SLP will give you a checklist tohelp you to determine thiswhen you give them the screening form. If you check *no adverse affect *, itwill not be necessaryfor the SLP to screen the child as the childwill notbe referred. Area of Concern: ____Complete Speech-Language Screening request from A-Team or ...
A full screening which includes speech, language, hearing, and vision is available for $40.00. A partial screening which includes speech and language is available for $25.00. In order to have your child screened, please complete the consent form on the back and return it to the school office along ...
... Person Filling Out Form: Student: 10#: Grade: Campus: Position: Language Observed: DIRECTIONS: If the referral to the RTI core team indicates speech concerns, each of the student'steachersmust complete this form for ... If the student has been referred to the RTI core team for speech screening, this form is ...
When to STOPscreening •Ifachildisunable to complete the task on a subset of the screening, it should be indicated on the form and screening should be halted. WHO conductsa screening? •Recommended practice indicates that the screenings be done by a speech -language pathologist or undera speech -language ...
If you would like to have your child screened, please complete the following form. A fee of $15 will be charged for each screening and should be attached to the ... I request that Carol S. DeBerardinis administer a Speech-Language screening to my child _____.
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