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Panda Speech Therapy

The School SLP Referral Kit ~ The forms you wish you had!

The School SLP Referral Kit ~ The forms you wish you had!

Regular price $5.00 USD
Regular price $8.00 USD Sale price $5.00 USD
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I created these forms after working in the public school systems for 11 years. The forms that were given to me didn’t quite meet my needs, so I created my own. I used these in addition and to replace some of the district’s forms. These forms will help you collect the necessary information to complete your speech and language evaluations in the schools. They can also be used in a clinic if desired. Make sure you follow your district’s/clinic’s referral policies when using these forms


  • Information from teachers (two forms): -1st grade and up: This form will collect all needed data from teachers about the student’s academic progress and standing. It collects current grades, strengths/weaknesses, and concerns in other areas such behavior, speech/language, motor skills, and counseling. -Prek-1st grade: This form is similar but asks about skills such as letter identification, sound identification, rote counting, colors, shapes, etc….
  • Speech and Language Teacher input forms (five forms): 1. Articulation 2. Stuttering 3. Language 4. Pragmatics 5. Voice/Resonance
  • Observation form: The standard form most districts use did not meet my needs for speech and language evaluations, so I created my own (one page, simple and easy to use).
  • Contact form: I keep a contact log in my referral paperwork, this is important if you are having difficulty getting a hold of parents and approaching timeline deadlines.
  • Caregiver information/case history: I designed this form to be simple and quick for parents to fill out (or use it as a guide for a parent interview). This information will help you fill out the medical history and sociological sections of the evaluation. My forms are inclusive and can be used for any family structure (father/mother, mother/mother, father/father, caregiver, etc…)
  • Release: This is a general release form if you need it. Many schools already have one but I liked this one better and used it at my previous district.
  • Clinic vs. School services: This is a great handout to give at the initial meeting. Sometimes parents do not understand the difference between these models.
  • Eligibility vs. Diagnosis handout: Many times parents confuse a school eligibility with a medical diagnosis (especially for Autism in my experience). This handout explains the differences between Special Education Eligibility, 504 Eligibility, and a Medical Diagnosis.
  • Strategies for teachers: This is a great one page guide for teachers (covers articulation, language, stuttering, and social skills.
  • BONUS: Parent Questionnaire. I send this out at the beginning of the year or when I get new students to get to know them better. It has information about the child’s interests, strengths, family activities, outside services, and other relevant information. It also has a section for religious or cultural considerations (example: if the student doesn’t observe certain holidays, etc..). Some of the questions are similar to the case history form.

 Many special education software programs have built in forms like this, but like I mentioned, did not meet my needs. You can scan these forms into your special education software program if needed.

Please email me BEFORE purchase with any questions:

***This is a digital download, you are responsible for printing the product to use.  This purchase is a ONE user license, sharing this file in any way is not permitted. Please respect copyright laws. Exception: You may share a page with your student's caregiver for home practice. 


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Physical Product: Refunds are accepted if item arrives damaged or not as described.

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    *You may not copy any part of this document (content, layout, format, idea, design) and reproduce it or create a similar product using my idea. All rights reserved to Panda Speech, LLC. This original activity was imagined and created by Amanda Schaumburg, all rights reserved. PLEASE RESPECT COPYRIGHT LAWS!!
    **If you are a therapist or educator, you may share a printed copy of a page to your client's caregiver for home practice (this is the only sharing permitted).