Speech and Language

PROGRAMS FOR STUDENTS WITH COMMUNICATION DISORDERS

SPEECH, LANGUAGE, AND HEARING DEPARTMENT

COMMUNICATION DISORDERS ‑ DEFINITION CD-01

SPEECH, LANGUAGE AND HEARING DEPARTMENT GUIDELINES CD‑02
Bilingual Protocol

FORMS FOR HEARING SCREENING PROCEDURES
Hearing Screening Worksheet CD‑03
Hearing Screening Results ‑ Form 1 (Passed/Normal) CD‑04
Hearing Screening Results ‑ Form 2 (Failed/Possible Problem) CD‑05
Results of Hearing Screening Recheck CD‑06
SLP Audiometric Results CD‑07
SLP Recommendation for Audiometric Evaluation (Form I) CD‑08
Permission for Audiological Evaluation (Form 2) CD‑09
Student Hearing History Form
Referrals to Educational Audiologist CD‑10
Guidelines for Referrals to the Educational Audiologist – Elementary
Guidelines for Referrals to the Educational Audiologist – Secondary

IDENTIFICATION AND PLACEMENT PROCEDURES
Teacher Referral Form CD‑11
Speech Screening Worksheet CD‑12
Kindergarten Roundup Worksheet CD‑13
Permission for Evaluation (First Notice) CD‑14
Permission for Evaluation (Second Notice) CD‑15
Parent Letter Regarding Voice Referral CD‑16
Medical Referral CD‑17
Results of Medical Evaluation CD‑18
Notice of Case Conference/Case Review Meeting CD‑19
School Notice of Case Conference (JS FORM)
One Page Parent Rights Notice (JS FORM)
Case Conference/Case Review Confirmation CD‑20
Case Conference/Case Review and IEP Report
Eligibility Worksheet – Communication Disorder Only
Evaluation Results, Pertinent Information and Observations (School Age)
Additional Speech/Language Evaluation Results
IEP Benchmark Page (blank – universal CD use)
IEP Benchmark Page (Articulation, Fluency, Voice)
IEP Benchmark Page (Language, AAC)
Profile Sheet – Articulation, Fluency, and Voice Objectives
Profile Sheet – Language Objectives (Semantics, Syntax, etc.)
Profile Sheet – Augmentative Communication
Record of Attempts to Arrange Parent Participation CD‑22
Recommendation for Enrollment (Parent at Meeting) CD‑23
Recommendation for Enrollment (Parent not in Attendance) CD‑24
4-Period Communication Disorder Progress Report
6-Period Communication Disorder Progress Report
Augmentative Communication Progress Report
“Overlapping” CC/CR Cover Sheet
Checklist for Case Conference
Checklist for Case Review
Checklist for Dismissal
Multi‑Disciplinary Evaluation Team Report CD‑30

MISCELLANEOUS DEPARTMENT FORMS
Speech, Language, and Hearing Therapy Schedule CD‑27
SLP Roster Change Form
Schedule Change CD‑28
Recheck/Evaluation Notice CD‑29
SLP Case Conference Tracking Form
SLP Case Review Tracking Form
Consent for Mutual Exchange of Information
Follow-Up Report to Doctor (Referrals)

PRESCHOOL SPEECH, LANGUAGE, AND HEARING FORMS
Permission for Evaluation CD‑31
Permission for Audiological Evaluation CD‑32
SLP Case Conference Tracking Form
Record of Attempts to Arrange Parent Participation CD‑33
Evaluation Results, Observations and Pertinent Information (Preschool)
Recommendation for Enrollment CD‑34

EDUCATIONAL AUDIOLOGIST'S FORMS
Permission for Audiometric Testing (3 forms) CD‑37
Parent Letter Concerning Medical Referral (3 forms) CD‑38
Medical Referral by Educational Audiologist CD‑39
Audiological Evaluation Report CD‑40
Audiological Report CD‑41
Audiologist's Follow-up Letter CD‑42
Miscellaneous Educational Audiologist Forms