FORMTEXT Enter District Name Here Communication Rating Scale: Language

Date: Student’s Full SSID: Date of Birth: Grade: School: SLP:

Non-Disabling Mild Moderate Severe 0 4 6 8 Language skills are Language skills are Language skills are Language skills are within the expected mildly impaired moderately impaired severely impaired range Functional Assessment Form/Structure Form/Structure Form/Structure Form/Structure Content Semantics Content Content Semantics Content Semantics Semantics Use/Pragmatics Use/Pragmatics Use/Pragmatics Use/Pragmatics 0 3 4 6 Scores on Scores on Scores on Scores on Standardized/ Standardized Standardized Standardized Standardized Norm-Referenced instruments are within instruments are within instruments are within instruments are 2 or Assessment 1 1/3 standard 1 1/3 to 1 2/3 1 2/3 to 2 standard more standard See Note deviations below the standard deviations deviations below the deviations below the mean or above the 9th below the mean or mean or from the 4th 2nd percentile. percentile. from the 9th to 5th to 2nd percentile. percentile. 0 4 6 8 Adverse Effect on No interference with Minimally impacts Moderately interferes Seriously limits Educational performance in the performance in the with performance in performance in the Performance educational setting. educational setting. the educational educational setting. setting. Total Score 0-7 8-12 13-17 18-22 Rating Scale Non-disabling Mild Moderate Severe Severity Rating 0 1 2 3

Comments:

NOTE: Not all standardized measures have a consistent correlation among standard deviations, standard scores, and percentiles. This section should only be marked after the standard score or percentile has been compared to the standard deviation according to the test manual for that specific test.

1 | P a g e Communication Rating Scale: Language February 2012