Speech and Language Screening Form

Speech and Language Screenings

Student's Name

First Last

Date of Birth

Age

Phone

Teachers Name

Please check the following

My child has permission to participate in the speech-language screening. I will bring cash, check or send a Venmo payment for 20.00.

My child has permission to participate in the occupational screening. I will bring cash, check or send a Venmo payment for 20.00.

I am choosing not to participate in the screening