Teacher Articulation Observations

Teacher completing this form: ___________________________________ Date: ____________________

Student Name: __________________________________ Date of Birth: ______________________________

Parents: ________________________________________ Phone: ____________________________________

Background Information

Please list any background information you have for this student (e.g., ESL, retained previously, medical concerns, hearing/vision information, attendance, etc.) _______________________________________________________ ____________________________________________________________________________________________

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Specific Area(s) of Concern

Please check area of concern and what applies. (Please be as specific as possible when describing your student).

¨ Expressive Language

□ Speech is disorganized □ Difficulty expressing thoughts/ideas

□ Difficulty generating sentences □ Reduced oral vocabulary compared to peers

□ Poor oral retell □ Difficulty participating in class discussions

Describe:_____________________________________________________________________________

¨ Listening Comprehension

□ Difficulty following directions □ Difficulty responding to questions

□ Reduced vocabulary compared to peers □ Doesn’t request clarification

□ Difficulty attending to classroom activities

Describe:_____________________________________________________________________________

¨ Articulation (please use “Teacher Articulation Observations” form as well)

□ Difficult to understand □ Speaks quickly

□ Frustrates easily when misunderstood □ Has more sound errors than peers

□ Reading/writing in error □ Peers notice difference in student’s speech

Describe:_____________________________________________________________________________

¨ Fluency or Stuttering

□ Difficulty starting words/sentences □ Repeats sounds/words several times

□ Unusual facial or body movements when trying to speak

Describe:_____________________________________________________________________________

¨ Pragmatics or Social Language

□ Difficulty following classroom routines □ Difficulty initiating social communication

□ Reduced eye contact □ Limited facial affect

□ Over or under emotional □ Difficulty participating in conversations

Describe:_____________________________________________________________________________

In your opinion, does the student’s area(s) of difficulty adversely affect his or her academic performance?

If yes, please explain. ___________________________________________________________________________

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Please add any information that you feel is important for the Local Support Team (LST) to know about your student______________________________________________________________________________________

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Thank you for your time in filling out these forms. Please fill out the “Teacher Articulation Observations” form IF you have articulation or sound error concerns for your student.

Liberty Hill Elementary

Teacher Information for Speech-Language