Initial Speech and Language Evaluation Report Format
Initial Speech Evaluation Report
(Articulation, Voice, or Fluency)
Evaluation for articulation, voice or fluency must be conducted in accordance with the requirements of N.J.A.C. 6A:14-3.4(f). The evaluation includes the use of standardized tests, where appropriate or required, and a functional assessment of academic performance and, where appropriate, behavior.
Student Name: _________________________ Date of Birth: _______________
Address: ______________________________ School: ___________________
Date(s) of Evaluation: ____________________ Teacher: __________________
Evaluator: _____________________________ Grade: ____________________
Developmental/educational history:
Parent interview:
Teacher interview:
Interventions documented by the classroom teacher(s) and others who work with the student: (Discuss the effectiveness of the interventions.)
Educational impact of the communication pattern on the student’s performance in the classroom: (Discuss the written information on educational impact provided by the classroom teacher.)
Structured observation: (Must be in other than a testing session)
Informal measure(s): (Specify the name or type of informal measures used. These may include, but are not limited to, an oral mechanism exam, analysis of speech sample, informal rating scale, criterion-referenced tests and self-report. Discuss the results.)
Standardized test(s) administered (where required or appropriate): (Specify the standardized tests used. If the assessment was not conducted according to standard conditions, indicate the extent to which the assessment varied from standard conditions.)
Summary: (Discuss the student’s current functioning and analysis of instructional implication(s) with respect to the student’s communication pattern. Also, include a statement regarding any relevant behavior of the student, either reported or observed, and the relationship of that behavior to the student’s academic functioning [N.J.A.C. 6A:14-3.4(h)].)
_____________________________ ________________
Speech-Language Specialist Date of Report
Sample initial speech evaluation report (ESLS) – 9/06
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