Talk Tracker Referral Sheet
Talk Tracker Referral Sheet
Quick speech and language screener for classroom teachers
Student Name
Grade / Class
Date of Birth
Referring Teacher
Date of Referral
Primary Language
1. Speech Sound Production
Focuses on articulation, clarity of speech, and sound usage.
Deletes or substitutes sounds
e.g., says "tat" for "cat", "yeyo" for "yellow", or "tar" for "star".
Unclear speech with peers
Classmates frequently struggle to understand their ideas or stories.
Unclear speech with adults
Unfamiliar listeners struggle to understand the student even in context.
Lisping or distorted sounds
"S", "Z", or "R" sounds are consistently slushy, whistle, or distorted.
Speech blocks or repetitions
Repeats words/sounds (e.g., "b-b-baby") or exhibits visible physical tension when trying to talk.
2. Language & Expression
Focuses on understanding directions, vocabulary, and sentence creation.
Struggles with directions
Difficulty following multi-step or conditional spoken directions.
Limited vocabulary selection
Relies on generic words like "thingy," "stuff," or "that" to express thoughts.
Incomplete or disordered sentences
Omits pronouns, plural forms, verb endings, or mixes up word order.
Difficulty sequencing events
Struggles to retell a simple story or share a personal experience logically.
Word-finding struggles
Experiences noticeable pauses, fillers ("um", "like"), or frustration during recall.
3. Educational Impact
How does this student's communication affect classroom engagement?
Academic struggle
Negatively impacts reading, writing, or verbal evaluations.
Social avoidance
Avoids speaking up, answering questions, or working in groups.
Emotional frustration
Shows sadness, anger, or shuts down when communication breaks down.
Teacher Observations & Specific Examples Please write concrete examples of observed speech/language behaviors
Teacher Initials:
Date Completed:
Submitted forms will be reviewed by the SLP within 5 business days.
