Spreadsheet: 5c6a5c8e-9648-4e99-9f23-a508b023eddf
Sheet: Sheet1

 | Speech and Language Clinic at SUNY Geneseo
 | [NAME] for CDSc 582: Clinical Practicum in Speech-Language Assessment
 | Student's Name:
 | Supervisor's Name:
 | Number of Clinical Hours: |  |  |  |  |  |  | Date:
 |  |  | Evaluation: |  |  |  |  | Grade:
 | Instructions:  Below is a checklist of diagnostic skills which must be satisfactorily achieved by the conclusion of the semester.  Rate each skill as Satisfactory, Unsatisfactory, or Not Observed.  To earn an overall passing grade of Satisfactory, all skills must be so rated by the conclusion of the semester.  Students will be notified of any Unsatisfactory skills by mid-semester so that adequate time is allowed to develop the skills.  Skills rated as Not Observed do not count against the student.
 | Student demonstrates competence for the following skills:
 |  |  |  |  |  |  |  |  |  | Satisfactory | Unsatisfactory | Not Observed |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | client | GRADE
 | A. | Conducts a speech-language screening. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Adult | S
 | B. | Selects appropriate evaluation tools given case history information. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Child | U
 | C. | Collects and uses case history information and meaningfully integrates it in testing procedures and the evaluation report.
 | D. | Administers a variety of standard and non-standard assessments across the lifespan, disorders, and diverse populations. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Mid-Semester
 | E. | Integrates knowledge of cultural and linguistic differences into diagnostic procedures. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Final
 | F. | Adapts evaluation procedures to meet client's needs.
 | G. | Accurately scores standard and non-standard assessment instruments.
 | H. | Interprets standard and non-standard assessment instruments.
 | I. | Interprets, integrates, and synthesizes all data to develop diagnoses and make appropriate recommendations.
 | J. | Writes an accurate and detailed diagnostic report.
 | K. | Adheres to report deadlines.
 | L. | Communicates effectively recognizing the needs, values, preferred mode of communication, and cultural/linguistic background of the client, family, caregivers, and relevant others.
 | M. | Provides guidance and counsel to clients, parents, and relevant others.
 | N. | Demonstrates good organizational skills.
 | O. | Conducts oneself in a professional manner.
 | P. | Is timely and dependable.
 | Q. | Adheres to the ASHA Code of Ethics.
 | We have discussed the information contained within this document on |  |  |  |  |  |  |  |  |  | .
 | _______________________________________________                          _____________________________________________
 | Student Signature |  |  |  |  |  |  | Clinical Supervisor Signature
 |  |  |  |  |  |  |  |  |  | Rev. 06/10