Practical Forms for Speech-Language Pathology Assistants
I maintained an appropriate relationship with the student
1 2 3 4 5
s session.
I considered the student's needs in selecting my materials
cting with this student.
I considered the student's cultural/linguistic needs in
cting with this student. 1 2 3 4 5
e student's age and educa
I was courteous and respectful with this student.
n. 1 2 3 4 5
I was dressed appropriately for this session.
sion.
I completed the assigned tasks during this session.
ined correct vs. incorrect responses.
I provided appropriate feedback to the student.
e work area was appropriate for this student.
I was aware of my professional boundaries during this ses
ocumented the results of the session appropriately.
I shared the results with my supervisor.
nts:
re:
SLPA SELF-EVALUATION OF INTERVENTION SESSION
Educational Setting
Note: This form may be used in conjunction with the Direct Observation Skills Brief Checklist
Date/Time of Session:
Rate the following on a scale of 1 (disagree) to 5 (agree).
1.
throughout the session.
2. I was self-confident in thi 1 2 3 4 5
3.
and intera 1 2 3 4 5
4.
selecting my materials and intera
5. I used language appropriate for th tion. 1 2 3 4 5
6. 1 2 3 4 5
7. I was punctual for the sessio
8. I was prepared for the session. 1 2 3 4 5
9. 1 2 3 4 5
10. I used time efficiently during this ses 1 2 3 4 5
11. 1 2 3 4 5
12. I accurately determ 1 2 3 4 5
13. 1 2 3 4 5
14. Th 1 2 3 4 5
15. sion. 1 2 3 4 5
16. I d 1 2 3 4 5
17. 1 2 3 4 5
Comme
SLPA Signatu
Copy freely American Speech-Language-Hearing Association
