Speech and Language Informal Assessment Questionnaire
Please complete the Speech and Language Informal Assessment Questionnaire to help us better understand communication strengths and areas for growth.
Age of the person being assessed
*
How clearly is speech understood by others?
*
Not understood
1
2
3
4
Always understood
5
1 is Not understood, 5 is Always understood
How often does the person repeat themselves to be understood?
*
Never
1
2
3
4
Very often
5
1 is Never, 5 is Very often
Please rate the following areas of language and communication:
*
Rows
Never
Rarely
Sometimes
Often
Always
Follows directions
1
2
3
4
5
Understands questions
6
7
8
9
10
Expresses ideas clearly
11
12
13
14
15
Uses appropriate grammar
16
17
18
19
20
Participates in conversation
21
22
23
24
25
Does the person have difficulty finding the right words when speaking?
*
Never
Sometimes
Often
Always
How well does the person understand spoken language in daily situations?
*
Not at all
1
2
3
4
Completely
5
1 is Not at all, 5 is Completely
How comfortable is the person when communicating with peers?
*
Very uncomfortable
1
2
3
4
Very comfortable
5
1 is Very uncomfortable, 5 is Very comfortable
Does the person use gestures or facial expressions to help communicate?
*
Never
Sometimes
Often
Always
Please rate the person’s participation in group activities.
*
Does not participate
1
2
3
4
Actively participates
5
1 is Does not participate, 5 is Actively participates
Additional comments (optional)
Submit Assessment
Should be Empty: