DIRECTIONS

By completing this checklist to the best of your ability, you will help us match your skills and the areas of interest with our available assignments. Please place a check (?) in the column that most accurately describes your level of experience with each skill.

*If you do not have access to a fax machine, then copy/paste the completed checkist into an email or an attached word document and send it to info@slpschoolstaffing.com  

EXPERIENCE LEVELS

1  = Very Experienced

2  = Experienced

3  = Some Experience

4  = No Experience

Ped- Pediatric Experience

Adult- Adult Experience 

CLINICAL SETTINGS

1

2

3

4

PED

ADULT

Home Health

Hospital

Outpatient Rehab

Inpatient Rehab

Private Clinic

Public School

Skilled Nursing Facility

 COMMUNICATION DISORDERS

 1

 2

 3

 4

PED

ADULT

Aphasia

Apraxia

Articulation

Dysarthria

Dysphagia

Stuttering

Hearing Impairment

Language Disorders

Phonological Processing Disorders

Voice Disorders

OTHER RELATED DISORDERS

ADD/ADHD

Alzheimer’s/Dementia

ALS

Autism Spectrum Disorders

Cleft Palate

CVA

Cerebral Palsy

Learning Disability

Mental Retardation

Multi-Handicapped

Parkinson’s Disease

Traumatic Brain Injury

DIAGNOSTIC SKILLS

Apraxia Battery for Adults

Arizona Battery for Communication Disorders of Dementia

Boston Diagnostic Aphasia Exam-3 (BDAE)

Communication Activities for Daily Living-2 (CADL)

Childhood Autism Rating Scale (CARS)

Clinical Evaluation of Language Fundamentals-4 (CELF)

Comprehensive Assessment of Spoken Language (CASL)

Comprehensive Receptive Expressive Vocabulary Test-2 (CREVT)

Comprehensive Test of Phonological Processing (CTOPP)

Evaluation of Acquired Skills in Communication-R (EASIC)

Expressive One Word Picture Vocabulary Test-2000 Ed. (EOWPVT)

Gilliam Aspergers Disorder Scale (GADS)

Gilliam Autism Rating Scale (GARS)

Goldman Fristoe Test of Articulation-2 (GFTA)

Khan-Lewis Phonological Assessment-2 (KLPA)

Minnesota Test for Differential Diagnosis of Aphasia (MTDDA)

Photo Articulation Test-3 (PAT)

Pragmatic Language Skills Inventory (PLSI)

Preschool Language Scale-4 (PLS)

Porch Index of Communication Abilities

Receptive-Expressive Emergent Language Test-3 (REEL)

Receptive One-Word Picture Vocabulary Test 2000 Ed. (EWOPVT)

AGE GROUPS TREATED

YES

NO

Early Intervention (Birth to 3 years) 

Preschool (Ages 3 to 5 years)

Elementary School 

Middle School 

High School

Adult 

SUPERVISORY ROLES

YES

NO

Director 

Supervisor 

CFY Supervisor 

Consultant