About this Form
Form number: 336-25
Audience: School Staff
Last revised: November 2001
INSTRUCTIONS: This form is used by speech-language pathologists screening students Pre-K through Grade 12. This may be an initial contact or a recheck of a previous screening. (A student may not be identified as disabled on the basis of screening data.) Permission for screening must be obtained from the parent/guardian. A copy is placed in the confidential folder.
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