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Test

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Submitted By sindisokhela
Words 309
Pages 2
Rochelle Seukaran
Speech – Language Therapist
B. Comm Path - Speech - Language Pathology (UKZN)

71 Makuertan Avenue

P. O. Box 24597

Cell: 0748972184

PR. No. : 0472298

Durban North

Broadlands

Email:rochelle.seukaran@gmail.com

HPCSA No.: ST 0005428

4051

4156

Questionnaire for Educators
Date: ___________________

Name of school: __________________________________

Learner’s Name: __________________________ Grade: ________ Teacher: _______________________

Dear Sir/Madam, the above mentioned learner from your class has being referred for a Speech- Language
Assessment. Please fill in the form below, as your input is valuable to the assessment findings.

1.1. How would you describe his/her performance and rate of progress at school?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

1.2. Is the learner able to follow instructions adequately? Elaborate if needed.
_____________________________________________________________________________________
_____________________________________________________________________________________

1.3. Does he/she appear to present with a hearing problem?
_____________________________________________________________________________________

1.4. Does he/she have any difficulty pronouncing his/her words? Is his/her speech unclear?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

1.5. When speaking, does the learner put the words in the correct order? (sentence grammar)

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