Speech Therapy Employment
     Ready to begin the process at MTC?    Toll free 866-447-6916

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)*
Email address*
Phone*
Address
City
State
5-digit zip code *
Type of qualifications
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
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
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


III. Diagnostic skills
ALPS (Aphasia Language
Perf. Scale)
Boston
CADL (Comm. Ability Daily)
CELF-3
Detroit
Minnesota (Schuell)
OWLS (Oral & Written
Language Skills)
PICA (Porch Index of
Com. Ability)
Token
Western Aphasia
Battery (WAB)


IV. Medicare guidelines
Daily Treatment Notes
Measurable Goals
Medicare Documentation
Narrative Format
SOAP Notes


V. Program development
Community Awareness of your Services
Establishing a Caseload
In-Services
Interaction with OT
Interactionwith Physician
Interaction with PT
Multidisciplinary Approach
Referral Development
Screenings
Staff Education
Writing Grants


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!
Copyright, 2008-2009 My Therapy Company, Inc., all rights reserved
P.O. Box 936 Fairfield, IA 52556, Regional Office: 770 Cragmont Avenue Berkeley, CA
Toll Free - 866.447.6916 Website by Prairiecomm