ALBUQUERQUE PUBLIC SCHOOLS
Speech and Language Initial Evaluation
Name:
Date of Birth:
Age:
Gender:
Test Date:
Home Language:
Vision:
Evaluator:
School:
Student #:
Grade:
Referral Date:
Report Date:
Student's Primary Language:
Hearing:
Parent(s):
_______________________________________________________________
Reason for Referral and Background Information
_______________________________________________________________
****See SLP Handbook for detailed description of what is needed in
each area, if not listed below.
Include in your paragraph
 Relevant case history
 Health history
 Other diagnosis
 Special ed eligibility, time in SLP services and level of service
 Dominant language of the home.
 NMELPA scores if applicable
Evaluation procedures are designed to identify areas of strengths and concerns.
The results of the evaluation are as follows:
Behavior and Attention:
 Comment on attention, cooperation, motivation, delayed or self-correction.
Anything that might affect evaluation results.
_______________________________________________________________
Clinical Observations
________________________________________________________________
Language Evaluation and Assessments
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Classroom Based Assessments:
 Important to include current DIBELS, A2L scores or current district
reading and math assessment.
 Classroom Performance Assessment (CPA) is a good tool to use to help
with this area.
Classroom Performance:
 Include comments from teachers on student’s performance and/or
relevant observations.
Functional Assessment:
 Include a short comment on how this student is functioning in the regular
environment with their peers. This comment is required by IDEA.
Standardized Assessments:
Tests results may be reported as Standard scores (St. Sc.). These scores have
a mean of 1—and a standard deviation of 15, unless otherwise noted.


Standardized test (s) listed with brief description
Composite or total test scores must be used to help determine eligibility.
Oral Language Sample:
 Either with a sufficient number of utterances to use a standardized
measure or analyzed for descriptive observation only
Speech Evaluation
Articulation:
 Articulation test results
 Intelligibility rating
 Stimulibility Assessment
 Other relevant information, e.g. classroom performance, functional
assessment, observation, connected speech sample
Voice:
 Medical assessment needs to be done prior to qualifying
Fluency:
Oral Structure and Function:
 To be done on all speech evaluations
 Note deviations from normal oral structure/dentition
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
Mobility of lips, tongue, palate, jaw
_________________________________________________________
Assessment Summary and Educational Impact
_________________________________________________________
Synthesize all information obtained
Look for patterns
How do scores, etc,
Strengths and concerns highlighted
Strengths:
Concerns:
_________________________________________________________
Eligibility Statement and Recommendations
_________________________________________________________
Based upon the above testing information ____does/ does not appear to meet criteria as a
Speech Language Impaired student in the area of _________(artic, voice, fluency or
language). A speech and language impairment is a communication disorder such as
stuttering, impaired articulation, language impairment, or a voice impairment that
adversely affects a child’s educational performance in academics, social-emotional or
vocational areas. Final determination of this educational eligibility and all service
recommendations will be made by the Multidisciplinary Team.
Or
Based upon the above testing information, clinical observations and ________
performance in the classroom setting __________ does appear to meet criteria as a
Specific Learning Disabled student in the area of _________ (oral expression or listening
comprehension). A specific learning disability is a disorder in one or more of the basic
psychological processes involved in understanding or in using language, spoken or
written, which may manifest itself in an imperfect ability to listen, think, speak, read,
write, spell, or to do mathematical calculations. Final determination of this educational
eligibility and all service recommendations will be made by the Multidisciplinary Team.
Or when not considering an eligibility but considering a need
At the present time, ______does/does not appear to have significant speech and/or
language problems that impact educational performance.
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Eligibility, as defined by state and local standards, requires a determination of need for
Special Education services. This determination must be made by the Multidisciplinary
Team.
Accommodation suggestions:
 List any strategies/accommodations needed in the classroom that you
may have observed or that appear to work.
________________________________
Speech language Pathologist CCC-SLP
___________________
Date
Test interpretation completed on ______________ by_________________
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