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Speech & Language Pathologist
Skills Proficiency Inventory

By completing this checklist to the best of your ability, you will help us match your skills and the areas of interest with our available assignments. Please choose the answer that most accurately describes your level of experience with each skill.

Use the following format to indicate your levels of experience.

3 - Very experienced
2 - Experienced
1 - Some experience
0 - No experience

Ped - Pediatric experience
Adult - Adult experience

Note: you can combine answers. For example:“1, adult”

Basic Information
Name (first, last)*	Required.
Email address*	Required.Invalid format.
Phone*	Required.
Address
City
State
5-digit zip code *	Required.
Type of qualifications	Choose SLP CFY
Today’s date
I. a) Overall experience in clinical settings:
I. b) Specific experience in clinical settings:
Home Health
Hospital
Outpatient Clinic
Private
Private School
Skilled Nursing Facility
II Experience with communication disorders
Language Disorders Laryngetomy Learning Disability Low Level Functioning Patients Mental Retardation Multi-Handicapped Non-Oral Parkinson’s PDD Phonological Disorders Trachs Traumatic Brain Inquiry Ventilator Dependent Patients Videofluroscopy Voice ADD/ADHD ALS Alzheimer's (dementia) Aphasia Apraxia Articulation Autism Spectrum Disorders Cerebral Palsy Cleft Palate CVA Dysarthria Feeding Disorders Fluency Head Trauma Hearing_Impaired
III. Diagnostic skills
Minnesota (Schuell) OWLS (Oral & Written Language Skills) PICA (Porch Index of Com. Ability) Token Western Aphasia Battery (WAB) ALPS (Aphasia Language Perf. Scale) Boston CADL (Comm. Ability Daily) CELF-3 Detroit
IV. Medicare guidelines
Daily Treatment Notes
Measurable Goals
Medicare Documentation
Narrative Format
SOAP Notes
V. Program development
Multidisciplinary Approach Referral Development Screenings Staff Education Writing Grants Community Awareness of your Services Establishing aCaseload In-Services Interaction with OT Interactionwith Physician Interaction with PT
VI. Therapy skills/experience
Accent Reduction
Augmentative/Alternative Communication
Aural Rehabilitation
Communication Boards
Discrete Trial Training
Early Intervention
Foreign Language
Sign Language
VII. Age groups treated
0-3 years Early Intervention
3-5 years Pre-School
5-11 years Elementary School
14-18 years High School
19-22 years
23-39 years
39-64 years
65 plus years
VIII. Supervisory roles
Chief/Director
Supervisor
Intern supervisor
CFY supervisor
Consultant
IX. Languages Please list foreign language training and level of competency, such as conversational, reading, writing and ability to easily provide therapy to others.
X. Additional skills  Please list any other skills and talents you might have. Be generous!

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