Teaching · Speech & Language

A referral the speech-language pathologist can act on.

Mark what you notice and the form asks the follow-up questions for that kind of concern: which sounds, how language compares with peers, what stuttering looks like, how long a voice change has lasted. It records what has been tried and what is still missing, then writes the summary.

Start a referral What you get

$12one-time · every device you sign in on

Buy · $12

Included with Caveat Classroom and Whole-school licenses. Or get it in the Speech & Language toolkit, $79 for 72 items.

The referral form

Records are keyed by initials or a code, never a name, and stay in this browser. The example is made up.

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What you get

Teaching · Speech & Language$12 · included with Classroom and Whole-school licenses

What you finish with: A completed referral for each student, with a follow-up section for each kind of concern you marked, the strategies tried and how they went, and a check of what should be on file first (hearing and vision screening, the family told). A one-paragraph summary heads the printed form.
Who it is for: Classroom and special education teachers, school nurses, counselors and psychologists who bring a concern to a school speech-language pathologist, and the SLPs who want referrals in one consistent shape. Families can use it to write down what they see before a meeting.
Format: Browser form with sections that open for the concerns you choose. Several saved referrals, printed one at a time or as a blank paper form; CSV of every referral; export and import a file.
Access: $12 one-time, yours on every device you sign in on; the tool opens once you are signed in with it. Included with Caveat Classroom and Whole-school licenses. Also in the Speech & Language toolkit ($79) and the Teaching Suite pass ($199), and 1 more bundle. Everything you type stays in this browser; nothing is sent to Caveat.
Where it lives: The Speech & Language space in Caveat Teaching.
Support: Questions about an order, access or a correction: team@caveatacademic.com.

Drawn for this page. A referral starts with what the adult actually heard and saw, and with what is still missing from the file.

How to use it

Start a record with the student’s initials or a school code, and the date.
Choose each kind of concern you notice. A follow-up section opens for each one; answer what you can and leave the rest.
Describe one real example in your own words, then list the strategies tried and for how long.
Mark what is on file before the referral goes in. The summary flags anything missing, such as a hearing screening.
Print the referral for the speech-language pathologist, or export the file to move it to another computer.

Start a referral

What the form is for, and what it is not

A referral is a request to look closer

Nothing on this form decides whether a student has a speech or language impairment. Under IDEA that takes a full evaluation by a team, with the parent’s written consent, using more than one measure. The form collects what an adult notices so the speech-language pathologist can decide what to do next.

A parent can ask the school for an evaluation at any time. Classroom strategies are worth listing, but federal guidance says they cannot be used to delay or deny an evaluation when a disability is suspected.

Why the follow-up questions differ

Each kind of concern needs different information. For speech sounds, which sounds and whether strangers understand the student. For language, how the student compares with classmates of the same language background. For voice, how long the change has lasted, because a voice change that lasts more than a few weeks calls for a medical look. For a student who uses two languages, which ones, so an interpreter can be planned and a language difference is not mistaken for a disorder.

Keeping it private

Use initials or a school code. The page refuses anything that looks like a full name and keeps every record in this browser; nothing is sent anywhere. A printed referral is part of the student’s education record: store and share it the way your school handles records under FERPA.

Sources

Individuals with Disabilities Education Act regulations, 34 CFR 300.8(c)(11) (speech or language impairment), 300.111 (child find), 300.300 to 300.305 (consent and evaluation procedures).
U.S. Department of Education, Office of Special Education Programs. Memo 11-07 (January 21, 2011): a response to intervention process cannot be used to delay or deny an evaluation under IDEA.
American Speech-Language-Hearing Association. Practice Portal: Speech Sound Disorders: Articulation and Phonology; Spoken Language Disorders; Voice Disorders (asha.org/practice-portal).
American Speech-Language-Hearing Association. Bilingual Service Delivery (Practice Portal), on telling a language difference from a disorder.
Family Educational Rights and Privacy Act, 34 CFR Part 99.

The worked example is made up: no real student is described. This form does not screen, evaluate or diagnose, and it holds no state rules; your district’s referral procedures still apply. Support: team@caveatacademic.com.