Does the child initiate communication interactions?
Does the child respond to communication interactions?
Approximately how intelligible is the child to unfamiliar listeners?
Approximately how intelligible is the child to familiar listeners?
Does the child demonstrate frustration when he/she is not understood?
If yes, how?
Forms of communication used by child (please check all that apply and list examples of each):
If child uses pictures, what format?
Has an augmentative and alternative evaluation ever been completed in the past?
If yes, please provide name and contact info for evaluator:
Date of Evaluation:
Has any type of augmentative or alternative communication been used or recommended in the past?
If yes, what?
What is the child's primary mode of communication at home?
What is the child's primary mode of communication at school?
Responds to speaker:
Understands what is said to him/her:
Follows simple directions:
Follows complex, multi-step directions:
Can group similar items together (e.g. clothes, food):
Does the child understand more than he/she is able to communicate?
Describe child's reading skills:
What are the current therapy goals for the child?
What are the most important communication needs at home?
What are the most important communication needs in school/community?