Speech-Language-Pathologist Artifact Document


Mississippi-Speech-Language Pathologist Assessment

SLP Name:_________________________

School District: ______________________

Date of Artifact Submission: ____/_____/____

Artifact Submission Form


School: ____________________________

Grade Level(s):______________________

Identify the domain and standard addressed by the attached artifact. Please submit one artifact form per domain. Check all artifacts under the appropriate domain that you are submitting or will have available to review in your room.

Domain I: Planning

Example of objectives taught for articulation, language, voice, and/or fluency





Domain II: Assessment

Sample Caseload Files

Evidence in the caseload files provide the following assessment evidence:

Multidisciplinary Evaluation Report (MDE)

Standard Assessment protocols

Other assessment Data

Domain III: Instruction


Student data sheets/daily student data

Student homework/class folders

Domain IV: Learning Environment


Domain V: Professional Responsibilities

Sample Caseload Files

Evidence in the caseload files provide the following evidence of professional responsibilities

Individualized Education Plan

Parent Permission documentation

Referral to Placement documentation

Dismissal Documentation

Other evidence of professional responsibilities

Copy of schedule (including revised schedules throughout the year)

Copy of student progress report

Professional growth documentation

Documentation of providing guidance and leadership to school staff and parents through presentations, materials/resources, collaboration and participating in school initiatives