Speech Language Pathologist Lab
First Name:  
Middle Name:  
Last Name:  
Email Address:  
Date of Birth:  
Certifications:  
State Licensure:
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Level of Experience
Use the following values to rate your level of experience.

1 = No Experience
2 = Limited Experience/Supervision or Support Needed
3 = Experienced/Support Minimally Needed
4 = Proficient/Performs Independently

NEUROLOGICAL DISORDERS
Adaptive Feeding:  
ALS  
Alzheimer's (Dementia)  

Augmentative Communications:
Communication Boards  
Electronic Devices  

Aural Rehabilitation:
Hearing Aids  
Hearing Loss  
Dysarthria  

Dysphagia:
Trachs  
Ventilator Dependent Patients  
Videofluroscopy  
Fluency  
Parkinson's Disease  
Therapy Techniques  
Voice-Laryngectomy  

PEDIATRICS
Articulation  
Autism  
Cleft Palate  
Early Intervention  
Feeding Disorders  
Fluency  
Hearing Impaired  
Traumatic Brain Injury  

THERAPY SKILLS

Aphasia:
CVA  
Head Trauma  
Low Level Functioning Patients  

Oral Motor Disorders:
Apraxia  
Dysarthria  

CLINCAL SKILLS
Standarized Tests  
ALSP (Aphasia Language Performance Scale)  
Boston  
CADL (Communication Ability for Daily Living)  
Detroit  
Minnesota (Schuell)  
Pica (Porch Index of Communication Ability)  
Token  
WAB (Western Aphasia Battery)  
Screening  
Ability to Follow Directions  
Attention Span  
Expressive/Receptive Skills  
Familiarize Self with Chart  
Hearing  
Memory Skills  
Oral Motor Movement  

By checking this box, I attest that the information given is true and accurate to the best of my knowledge and that I am the individual completing this form. I hereby authorize Delta Flex Travelers to release this Skills Checklist to their client facilities in relation to consideration of employment as a provider with those facilities.
 
 
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