Speech and Language Screenings

Gan Ami is pleased to provide free screenings of children’s speech and language development for every Bet and new-to-school Gimel and Dalet. Speech Tree Therapy, LLC will provide screenings during the weeks of September 12th and 19th, and they will then provide a summary to each parent.

These screenings are an opportunity for your child to be seen by a professional Speech Language Pathologist (SLP) who may lend insight into any questions you have about your child’s speech and language development and will provide teachers with suggestions on best strategies to support children's progress.

Bet children: Screenings will occur during classroom observations.

New-to-School Gimel and Dalet Children: Screenings will occur during 15-minute on-on-one interactions with the SLP and will assess general speech and language skills as well as pragmatic (social language) skills.

Children who are currently receiving any speech therapy are still eligible for this screening.

Only children with parental consent (provided in this form)will be screened. Every parent must complete this form to accept or decline this service.

If you have more than one child, you must complete and submit this form for each child. After submitting one form, use the link again to complete the survey for another child.

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Child Name *
Child Birth Date *
MM
/
DD
/
YYYY
Child Class *
Name of Parent Completing This Form *
Is your child currently receiving any speech/language services?
*
Please provide information about the speech and language services that your child is receiving below. If your child is not receiving services, please skip to the section entitled "Parent Concerns."
Provider Name
Provider Email
Provider Phone Number
Is there any other information that you would like us to know?
I give permission to Gan Ami to share information with this provider about my child's speech language development for the purpose of supporting my child's progress in school.
Clear selection
Parent Concerns
I have concerns about my child's: (Please Specify)
Receptive Language (what they understand)
Expressive Language (what/how they are communicating with me)
Speech/Articulation (how they produce specific sounds or words)
Other
Please select below in order to consent to your child's participation in the screenings. 
Clear selection
If you did not check the above box,  please explain your reason for declining this service.
Submit
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