SPEECH PRACTICE

Speech Practice Help

Please submit this form for more information on obtaining speech practice help for your child.

Your Name
Telephone Number
Email address
Best way to reach you
Best time to call
Age of child
Has your child been previously assessed for Speech or a Learning Disability? If yes, please provide us with a copy.
- Yes
- No
Does your child have a school IEP? If so, please provide us with a copy.
- Yes
- No
What is your child currently struggling with?
What kinds of services has your child received at school to help with this?
What kinds of things have you already done at home to help your child?
Does your child have speech sounds they need to work on? If so, please list them here.
Additional Comments
School of Attendance
Street Address
City and State
Submit

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