SPEECH & LANGUAGE
Teacher Checklist
1st Grade
Name DOB Grade Date
Parents Phone Teacher
Speech Therapy is designed for students who are exhibiting a communication disorder that is adversely affecting their educational performance. The classroom teacher serves as an essential and vital participant in the intervention process. Please check the following items that apply to your student.
I. This student is demonstrating difficulty towards mastery of the following grade level TEKS/benchmarks:
The student listens actively and purposefully in a variety of settings.
The student listens and speaks to gain and share knowledge of his or her
own culture, the culture of others and the common element of cultures.
The student speaks clearly and appropriately to different audiences for
different purposes and occasions.
The student communicates clearly by putting thoughts and feelings into
spoken words.
II. Please check the following items that you feel best describe the communication difficulties of the student.
- Articulation
Substitutes sounds: for
Is not able to produce age appropriate sounds such as: p, m, h, n,
w, b, k,g, d, t, ng, f, y, s, l, r, ch, sh, z, v, th, j
Speech sounds unclear, imprecise, or sloppy
Is not understood by both familiar and unfamiliar listeners:
Rarely
Some of the time
Most of the time
All of the time
- Language
Has difficulty with color, shape, positional, time and/or number
concepts
Displays below average vocabulary
Cannot describe common objects
Unable to produce sentences containing: conjunctions,
prepositions and/or clauses
Is not able to accurately and sequentially relate experiences
about school, home, etc.
Incorrect use of irregular plurals, possessives, tense, and/or
comparatives (-er, -est)
Incorrect use of pronouns
Is not able to name opposites
Is not able to answer simple what, where,who, when, why, and
how questions
- Voice
Too soft/too loud
Nasal quality
Loss of voice, weak voice
Breathy, hoarse, harsh
Too high/too low
- Fluency
Repeats sounds, syllables and/or words
Blocks and sometimes can’t get words out
Excessive use of interjections e.g.: uh, um
Sound prolongations
Secondary characteristics i.e.: lip/jaw tension, eye blinking or loss
of eye contact
- Listening
Asks for repetition
Difficulty attending to a short story and answering simple
questions about it
Is not able to follow a 3-part command
Hesitates or does not respond when asked a question
III. Academic Achievement:
Student is doing above grade level work
Student is doing average grade level work
Student is doing low-average grade level work
Student is performing below grade level
IV. Student Progress:
Student is making making satisfactory progress
Student is making unsatisfactory progress due to:
frequent absences
other:
Benchmark scores:
Other:
V. Behavior Observation:
Disrupts class Cooperative
Distractible Average attention
Accepted by peers Rejected by peers
Completes work Does not complete work
Appears concerned for others Does not appear concerned for others
Next, schedule a meeting with the campus SLP.
Date of meeting:
Teacher signature: SLP signature:
SLP recommends:
Date of 2nd meeting:
Interventions tried: Data collected:
Results:
SLP recommends: