Updated 8/5/14
Student Name
KNOWLEDGE AND SKILLS ACQUISITION (KASA)
SUMMARY FORM FOR
CERTIFICATION IN SPEECH-LANGUAGE PATHOLOGY
Graduate Advisor
San Francisco State University
Communicative Disorders Program
Knowledge and Skills Acquisition (KASA) Summary Form
For Certification in Speech-Language Pathology
Last updated June, 2014
1

KNOWLEDGE AND SKILLS ACQUISITION (KASA)
SUMMARY FORM FOR
SPEECH-LANGUAGE PATHOLOGY
Instructions for Use
The Knowledge and Skills Acquisition (KASA) form summarizes a student's acquisition of the knowledge and skills delineated in the
Standards for the Certificate of Clinical Competence (SCCC). Entries are made only upon acquisition of the knowledge or skill; thus the
KASA is not an evaluation, but only a record that a particular knowledge or skill has been acquired.
Required Documentation
1. Students from CAA-accredited programs (Refer to "Automatic Approval" language in Standard I. Degree) must submit the "Verification by Program Director" page of the KASA when applying for certification.
2. All other applicants must submit the entire, completed document, including the "Verification by Program Director" page when applying for certification.
Use of the KASA Form
1. The CFCC encourages programs to use the KASA to demonstrate compliance with accreditation standards related to preparing students to meet ASHA certification requirements. However, programs may develop other documents to verify student's acquisition of knowledge and skills.
2. For students who must submit the entire KASA, and for academic programs wishing to use the KASA as a tracking document, indicate with a check mark in Column B whether each knowledge and skill was achieved. If a particular knowledge or skill was acquired through work completed in a specific course or courses, the title and number of the course(s) should be entered in Column C. If the knowledge or skills were acquired in clinical practicum, enter the title of the clinic, and the semester and year of the clinic, in Column E, to the right of the number of the practicum course listed in Column D. If the knowledge or skill was acquired through course work and/or clinical practicum, and/or lab or research activities, there should be entries in all of the applicable columns: C, D, and/or E.
3. Students and programs using the KASA are advised to keep a copy in a safe place, should they need to provide information to the
Council For Clinical Certification at a later date (e.g., upon application for reinstatement). Students and their advisors should review the
KASA form on an ongoing basis throughout the program.
4. CFCC encourages programs and students to periodically review the KASA (or other tracking documents developed by the program) to assist students in determining knowledge and skills already acquired and those yet to be attained.
Updated 8/5/14 2

Student Name
Knowledge And Skills Acquisition (KASA) Summary Form For Certification in Speech-Language Pathology
The KASA form is intended for use by the applicant during the graduate program to track the processes by which the knowledge and skills specified in the 2014 Standards for the CCC are being acquired. Each applicant should review the KASA form at the beginning of graduate study, and update it at intervals throughout the graduate program, and at the conclusion of the program. http://www.asha.org/Certification/2014-Speech-Language-Pathology-Certification-Standards/
The student, with input and monitoring of program faculty, must enter the semester and year that the course was taken in column B, as each of the knowledge and skills is acquired in academic coursework, and the semester and year of the clinic that was taken in column E, as each of the knowledge and skills is acquired in clinical training. It is expected that many entries will appear in the course work and the clinical practicum co lumns, with some entries, as appropriate, in the “Other” (lab, research, etc.) columns. Please enter the course or practicum number and title and description of other applicable activity. Optional courses (e.g., SPED791, SPED825, SPED794, SPED 743, SPED 746) should be filled out only if the student has taken the course.
Standard IV. Knowledge Outcomes
A
Standards
B
Requirement
C
Course #
D
Practicum
E
Other (e.g., labs, research) (Include description of activity)
Met (Date) Experiences
Standard IV-A. The applicant must demonstrate knowledge of the principles of the biological sciences, physical sciences, statistics, and the social/behavioral sciences.

Biological sciences (emphasizing a content area related to human or animal sciences)

Physical sciences (courses with a component of physics or chemistry)

Statistics

Social/Behavioral sciences (psychology, sociology, anthropology or public health)
Standard IV-B: The applicant must have demonstrated knowledge of basic human communication and swallowing processes, including the appropriate biological, neurological, acoustic, psychological, developmental, and linguistic and cultural bases. The applicant must have demonstrated the ability to integrate information pertaining to normal and abnormal human development across the life span
Basic Human Communication Processes

Biological CD660
CD651

Neurological CD660
CD668
CD661

Acoustic

Psychological
CD652
CD668
CD661

Developmental/Lifespan CD660
CD661

Linguistic

Cultural
CD668
CD660
CD668
Updated 8/5/14 3

Swallowing Processes

Biological CD651
CD661

Neurological

Acoustic

Psychological

Developmental/Lifespan

Linguistic

Cultural
Articulation

Etiologies

Characteristics
CD651
CD661
NA
CD651
CD651
NA
NA
Standard IV-C: The applicant must have demonstrated knowledge of communication and swallowing disorders and differences, including the appropriate etiologies, characteristics, anatomical/physiological, acoustic, psychological, developmental, and linguistic and cultural correlates in the following areas:
CD660
CD651
CD659
CD709
CD 768
Fluency

Etiologies

Characteristics
CD660
CD653
CD 768
Voice and resonance (respiration and phonation)


Etiologies
Characteristics
CD660
CD651
CD653
CD 768
Receptive/expressive language (phonology, morphology, syntax, semantics, pragmatics, prelinguistic communication, and paralinguistic communication) in speaking, listening, reading, writing, manual modalities

Etiologies

Characteristics
CD660
CD668
CD658
CD701
CD707
CD 768
Hearing, including the impact on speech and language


Etiologies
Characteristics
CD652
CD705
CD654
CD 768
Swallowing (oral, pharyngeal, esophageal, and related functions, including oral function for feeding; orofacial myology)

Etiologies

Characteristics
CD651
CD659
CD710
CD 768
Cognitive aspects of communication (attention, memory, sequencing, problem-solving, executive functioning)

Etiologies

Characteristics
CD661
CD668
CD658
CD701
CD708
Updated 8/5/14 4

CD 768
SPED791
Social aspects of communication (challenging behavior, ineffective social skills, lack of communication opportunities)

Etiologies

Characteristics
CD701
CD706
CD707
CD768
SPED791
SPED794
SPED825
Augmentative and alternative communication modalities


Etiologies
Characteristics
CD663/
SPED 743
SPED 746
Standard IV-D: For each of the areas specified in Standard VI-C, the applicant must have demonstrated current knowledge of the principles and methods of prevention, assessment, and intervention for people with communication and swallowing disorders, including consideration of anatomical/physiological, psychological, developmental, and linguistic and cultural correlates.
Articulation

Prevention

Assessment

Intervention
CD656
CD659
CD709
CD 768
CD711/713
CD715
CD880
CD882
CD884
Fluency

Prevention

Assessment

Intervention
CD653
CD 768
CD711
CD715
CD880
CD882
CD884
Voice and resonance

Prevention

Assessment

Intervention
CD653
CD 768
CD711/713
CD715
CD880
CD882
CD884
Self-guided Visi-Pitch Lab
Self-guided Video Lab
Receptive and expressive language

Prevention

Assessment

Intervention
CD656
CD658
CD701
CD707
CD708
CD711/713
CD756
CD 768
CD715
CD880
CD882
CD884
Hearing, including the impact on speech and language

Prevention

Assessment

Intervention
CD652
CD654
CD705
CD 768
CD715
CD880
Swallowing

Prevention

Assessment

Intervention
CD710
CD 768
CD882 Self-guided Video Lab
Updated 8/5/14 5

Cognitive aspects of communication



Prevention
Assessment
Intervention
CD656
CD701
CD707
CD708
CD756
\CD 768
SPED791
CD715
CD880
CD882
CD884
Social aspects of communication



Prevention
Assessment
Intervention
CD656
CD701
CD706
CD707
CD708
CD710
CD756
CD768
CD715
CD880
CD882
CD884
SPED791
SPED794
SPED825
Augmentative and alternative communication modalities

Prevention not applicable

Assessment

Intervention
CD663/
SPED 743
CD715
CD880
CD882
CD884
Standard IV-E: The applicant must have demonstrated knowledge of standards of ethical conduct.
CD660
CD706
CD711
CD712
CD713
CD725
CD768
CD715
CD880
CD882
CD884
Standard IV-F: The applicant must have demonstrated knowledge of processes used in research and of the integration of research principles into evidence-based clinical practice.
ISED 797
CD656
CD701
CD706
CD707
CD708
CD709
CD710
CD756
CD715
CD880
CD882
CD884
CD768
Standard IV-G: The applicant must have demonstrated knowledge of contemporary professional issues.
SPED 788
CD712
CD725
CD706
CD 768
Standard IV-H: The applicant must have demonstrated knowledge of entry level and advanced certifications, licensure, and other relevant professional credentials, as
Updated 8/5/14 6

well as local, state, and national regulations and policies relevant to professional practice.
CD712
CD725
Updated 8/5/14 7

Student Name
Knowledge And Skills Acquisition (KASA) Summary Form For Certification in Speech-Language Pathology
Standard V. Skills Outcomes
Standard V-A: The applicant must have demonstrated skills in oral and written or other forms of communication sufficient for entry into professional practice.
Written English Proficiency Requirement met with (list date next to the way in which this requirement was met):
Oral communication skills sufficient to achieve effective clinical and professional interaction with clients/patients and relevant others
Written communication skills sufficient to achieve effective clinical and professional interaction with clients/patients and relevant others.
GRE Analytical Writing Skills Test
CSET Writing Skills
Other:____________
CD706 CD715
CD712
CD725
CD768
CD768
CD706
CD880
CD882
CD884
CD715
CD880
CD882
CD884
Standard V-B: The applicant for certification must complete a program of study that includes supervised clinical experiences sufficient in breadth and depth to achieve the following skills outcomes (in addition to clinical experiences, skills may be demonstrated through successful performance on academic course work and examinations, independent projects, or other appropriate alternative methods):
1. Evaluation (must include all skill outcomes listed in a-g below for each of the 9 major areas) a. Conduct screening and prevention procedures (including prevention activities) b. Collect case history information and integrate information from clients/patients, family, caregivers, teachers, relevant others, and other professionals c. Select and administer appropriate evaluation procedures, such as behavioral observations, nonstandardized and standardized tests, and instrumental procedures d. Adapt evaluation procedures to meet client/patient needs.
e. Interpret, integrate, and synthesize all information to develop diagnoses and make appropriate recommendations for intervention f. Complete administrative and reporting functions necessary to support evaluation g. Refer clients/patients for appropriate services.

Articulation



Fluency
Voice and resonance, including respiration and phonation
Receptive and expressive language
(phonology, morphology, syntax, semantics, and pragmatics) in speaking, listening, reading, writing, and manual modalities

Hearing, including the impact on speech
Updated 8/5/14
CD656
CD659
CD709
CD711/713
CD768
CD656
CD653
CD711/713
CD768
CD656
CD653
CD711/713
CD768
CD656
CD658
CD701
CD707
CD708
CD711/713
CD756
CD768
CD652
CD715
CD880
CD882
CD884
CD715
CD880
CD882
CD884
CD715
CD880
CD882
CD884
CD715
CD880
CD882
CD884
CD715
8

 and language

Swallowing (oral pharyngeal, esophageal, and related functions, including oral function for feeding; orofacial myofunction)
Cognitive aspects of communication
(attention, memory, sequencing, problem-solving, executive functioning)
CD654
CD705
CD768
CD710
CD768
CD656
CD701
CD707
CD708
CD711/713
CD756
CD768
SPED791
CD880
CD882
CD884
CD715
CD880
CD882
CD884
CD715
CD880
CD882
CD884

Social aspects of communication
(including challenging behavior, ineffective social skills, lack of communication opportunities)
CD656
CD701
CD706
CD707
CD708
CD711/713
CD756
CD768
CD715
CD880
CD882
CD884
SPED825
SPED794

Communication modalities (including oral, manual, augmentative, and alternative communication techniques and assistive technologies)
CD656
CD663/
SPED743
SPED746
CD715
CD880
CD882
CD884
CD711/713
CD768
2. Intervention (must include all skill outcomes listed in a-g below for each of the 9 major areas) a. Develop settingappropriate intervention plans with measurable and achievable goals that meet clients’/ patients’ needs. Collaborate with clients/patients and relevant others in the planning process b. Implement intervention plans. (Involve clients/patients and relevant others in the intervention process) c. Select or develop and use appropriate materials and instrumentation for prevention and intervention d. Measure and evaluate clients’/ patients’ performance and progress e. Modify intervention plans, strategies, materials, or instrumentation as appropriate to meet the needs of clients/patients f. Complete administrative and reporting functions necessary to support intervention g. Identify and refer clients/patients for services as appropriate.

Articulation CD656
CD659
CD709
CD711/713
CD768

Fluency CD656
CD653
CD711/713
CD768

Voice and resonance, including respiration and phonation
CD656
CD653
CD711/713
Updated 8/5/14
CD715
CD880
CD882
CD715
CD880
CD882
CD715
CD880
CD882
9


Receptive and expressive language
(phonology, morphology, syntax, semantics, and pragmatics) in speaking, listening, reading, writing, and manual modalities

Hearing, including the impact on speech and language

Swallowing (oral pharyngeal, esophageal, and related functions, including oral function for feeding; orofacial myofunction)

Cognitive aspects of communication
(attention, memory, sequencing, problem-solving, executive functioning)

Social aspects of communication
(including challenging behavior, ineffective social skills, lack of communication opportunities)

Communication modalities (including oral, manual, augmentative, and alternative communication techniques and assistive technologies)
3. Interaction and Personal Qualities

a. Communicate effectively, recognizing the needs values, preferred mode of communication, and cultural/linguistic background of the client/ patient, family, caregivers, and relevant others

b. Collaborate with other professionals in case management
Updated 8/5/14
CD768
CD656
CD658
CD701
CD707
CD708
CD711/713
CD756
CD768
CD652
CD654
CD705
CD768
CD710
CD768
CD656
CD701
CD707
CD708
CD711/713
CD756
CD768
SPED791
CD656
CD701
CD706
CD707
CD708
CD711/713
CD756
CD768
SPED825
SPED794
CD656
CD663/
SPED743
SPED746
CD711/713
CD768
CD706
CD711
CD712
CD713
CD725
CD768
CD706
CD711/713
CD712
CD725
CD715
CD880
CD882
CD715
CD880
CD882
CD715
CD880
CD882
CD715
CD880
CD882
CD715
CD880
CD882
CD715
CD880
CD882
CD715
CD880
CD882
CD884
CD715
CD880
CD882
CD884
10



c. Provide counseling regarding communication and swallowing disorders to clients/patients, family, caregivers, and relevant others
d. Adhere to the ASHA Code of Ethics and behave professionally.
CD768
CD706
CD710
CD711
CD712
CD713
CD660
CD706
CD711
CD712
CD713
CD715
CD880
CD882
CD884
CD715
CD880
CD882
CD884
CD725
CD768
Standard V-C: The applicant for certification in speech-language pathology must complete a minimum of 400 clock hours of supervised clinical experience in the practice of speech-language pathology. Twenty-five hours must be spent in clinical observation, and 375 hours must be spent in direct client/patient contact .
25 observation hours
375 clinical clock hours
Requirement met (semester and year):
Requirement met (semester and year):
Standard V-D: At least 325 of the 400 clock hours must be completed while the applicant is engaged in graduate study in a program accredited in speech-language pathology by the Council on Academic Accreditation in Audiology and Speech-Language Pathology.
Total number of clinical clock hours completed while in graduate program :
Updated 8/5/14 11

Student Name
Knowledge And Skills Acquisition (KASA) Summary Form For Certification in Speech-Language Pathology
CA Licensure Requirements: http://www.speechandhearing.ca.gov/applicants/app_pack_slp.shtml

60 semester units (su) in normal development, function, and use of speech, hearing, and language and information
Requirement met (semester and year):
Undergrad (36 su):
CD660
CD651
CD653
CD654 about, and training in, management of speech, voice, hearing, and language disorders.

At least 24 of the required 60 semester
Requirement met (semester and year):
CD652
Graduate (35 non-clinical su):
CD701
CD705
CD706
CD668
CD708
CD709
CD656
CD658
CD659
CD768
ISED797
CD710 SPED788 units shall be related to disorders of speech, voice, or language.

These 60 units do not include credit for thesis, dissertation, or clinical practice.
CD707 CD756 CD712
CD725

300 clock hours of clinical experience with individuals representative of a wide
Requirement met (semester and year):
CD661
CD663/ SPED 743
CD664
Clinical settings from the following kinds of settings: SFSU CD Clinic; public and/or public schools; hospital / rehabilitation / community: spectrum of ages and communication disorders in 3 different clinical settings
(2532.2-b)
Graduate (24 clinical practica su)
CD711 x2
CD713
CD715
CD880-C1
Clinical Setting 1 : SFSU CD Clinic (CD 880-711-C1, CD 880-711-C2, CD-
713-A)
Clinical Clock Hours Earned :
CD880-C2
CD880-A
CD882
CD884
Clinical Setting 2 :
Clinical Clock Hours Earned :
Clinical Setting 3 :
Clinical Clock Hours Earned :
Clinical Clock Hours Total :
Updated 8/5/14 12

Student Name
Knowledge And Skills Acquisition (KASA) Summary Form For Certification in Speech-Language Pathology
Speech-Language Pathology Services Credential Requirements: http://www.ctc.ca.gov/credentials/leaflets/cl879.pdf
Requirement met (semester and year): Completion of CD 715 and CD 725
(which requires SFSU commissionapproved specialized preparation program resulting in the formal recommendation for the credential by the college or university where the program was completed
[http://cig.ctc.ca.gov/cig/CTC_apm/apm_o ne.php?-recid=70&-prior=all.php])
Requirement met (semester and year): Completion of Basic Skills Requirement
(CBEST)
Updated 8/5/14 13

KEY TO COURSES
CD 300 Human Communicative Development and Disorders
CD 651 Anatomy and Physiology of the Speech Mechanism
CD 652 Audiology
CD 653 Voice & Fluency
CD 654 Audiometry
CD 655 Dynamics of Communication Development
CD 656 Diagnosis of Communicative Disorders
CD 658 Communication Development and Disorders
CD 659 Articulatory and Phonological Disorders
CD 660 Communicative Disorders
CD 661 Neurolinguistics
CD 663/ SPED 743 Augmentative and Alternative Communication
CD 668 Language Acquisition and Development
CD 701 Seminar in Language Differences and Disorders in Children
CD 705 Aural Rehabilitation
CD 706 Seminar in Counseling in Communicative Disorders
CD 707 Advanced Seminar in Language Disorders in Children
CD 708 Seminar in Neurogenic Disorders of Language
CD 709 Seminar in Motor Speech Disorders
CD 710 Seminar in Dysphagia
CD 711 Seminar in Therapy for Functional Communicative Disorders
CD 712 Medical Internship Workshop
CD 713 Seminar in Therapy for Organic Communicative Disorders
CD 715 Clinical/Rehabilitative Experience in the School
CD 725 School Internship Workshop: Communication Handicapped
CD 756 Adv. Dx. of Communicatively Handicapped Adults & Children
CD 768 Seminar in Advanced Clinical Skills
CD 880 Advanced Communication Therapy
CD 882 Internship in Communicative Disorders
CD 884 Advanced Diagnosis in Communicative Disorders
CD 664 American Phonetics
ISED 797 Seminar in Educational Research
3
3
SPED 746 Teaching Individuals with Physical and Other Health Impairments 3
SPED 788 Professional, Legal, and Ethical Practices 3
3
2
6
3
SPED 791 Nature of Autism Spectrum Disorders
SPED 825 Communication, Behavior and Instruction: Autism*
SPED 794 Socialization and Imagination: Autism
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
1
1
1
8
1
3
3
3
3
3
Updated 8/5/14 14