Teacher Input Form for Speech
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What is your name? *
What are the student's initials that you are completing this form for? Example: JoSm for John Smith *
What concerns do you have regarding the student's social skills? This can include: demonstrating appropriate behaviors, initiating and ending conversation, contributing appropriate comments and topics, maintaining the topic, turn-taking, understanding body language, and problem-solving.
What concerns do you have regarding the student's language skills? This can include: speaking and writing in complete sentences, using correct grammar, range of vocabulary, inferencing, understanding sarcasm, answering comprehension questions, sequencing, and summarizing.  
What concerns do you have regarding the student's social emotional skills? This can include: sharing feelings, identifying emotions, problem-solving, and perspective taking. This can also include their mental health.
What concerns do you have regarding the student's articulation (their speech/how they produce sounds)? This can include making errors on certain sounds, like /r/ or /l/ sounding like a /w/ or having difficulty understanding the student when they speak because their speech makes it difficult to understand them.
What concerns do you have regarding the student's fluency (flow of speech)? This can include: repeating sounds, syllables, or sentences; holding out sounds, having "blocked" speech.
What concerns do you have regarding the student's voice? This can include: sounding monotone, volume, hoarse voice, etc.
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Would you like me to share the student's speech and language goals with you, if you don't have access to them already? *
How can I best help you and the student in your class? *
Do you have any additional concerns that you would like to share that were not covered in a previous question that would be important for me to be aware of? That can include observations, academics, etc. *
Was this form easy to fill out? *
How long did it take you to complete the form? *
Thank you for completing this form! You can email me at bkarp@alamedaunified.org with any questions or if you forgot to include something!
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