Speech & Language Pathologist
Skills & Proficiency Inventory

Please Return Completed Form to Us by Fax at (770) 887-1266*


Circle One:
     SLP              CFY

 

Name: _____________________________________________________________________________________
Last                             First                                Middle


 

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

 

 


 

Please describe additional language proficiency, if applicable.

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Please list any additional skills not covered above:

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Signed: _______________________________________________________________



Date: ______________________