Speech Tablets for Apraxia

SPEECH-LANGUAGE PATHOLOGIST APPLICATION INFORMATION

The completed application must be submitted by end of day on Monday, November 6, 2023.

Thank you for helping a family in need apply for the Speech Tablets for Apraxia program from Apraxia Kids. The Speech Tablets for Apraxia program provides iPads and protective cases to selected children with a diagnosis of apraxia of speech from moderate-to-low income families. No apps will be included and we have advised the child’s parents/caregivers to consult with you for recommendations.

You can read more about the Speech Tablets for Apraxia program, guidelines, and parent application here: https://www.apraxia-kids.org/speech-tablet-applications/

If you received this application link, the parent of the child in your care has given their permission and consent for you to provide relevant information about this child in your application portion. If you or your employer require a copy of written consent, we urge you to have the parent sign your form for your records.

Only parents or legal guardians may apply for a child. As part of the application process, the family must have you, their primary SLP:

Complete the questionnaire below, and
Upload a written speech-language evaluation report or provide a therapy summary report for this child.

ABOUT THE QUESTIONNAIRE

In addition to some general information, the questionnaire also includes:

Details about the child’s CAS diagnosis and therapy
Short answer portion for you to tell us more about if/how the child will benefit from AAC

ABOUT THE EVALUATION REPORT

You will be required to upload a written speech-language evaluation report or a therapy summary report.

A proper speech-language evaluation written report typically includes a developmental history, evaluation test scores, clinical probes and observations, professional recommendations, and a formal diagnosis of children apraxia of speech (CAS) or suspected CAS (sCAS).
Evaluations more than one year old for children ages 2.5-6 and evaluations more than two years old for children ages 7-18 will not be accepted.
Therapy summaries must be dated within 3 months of the date the application is filled out.
A therapy summary should include the child’s diagnosis, a listing of the long term and short-term goals with dates, progress during the reporting period for each goal, and recommendations for the next reporting period.
- If you are a family living in Ontario or Prince Edward Island:
- A report from your child’s SLP indicating characteristics of apraxia without an official diagnosis is acceptable.
- A letter from a physician indicating a diagnosis of apraxia is acceptable.

Without your help, the child will not be eligible for the program.

We truly appreciate your cooperation, in advance, and thank you for helping this family to apply.

2023 Speech Tablets for Apraxia
Speech-Language Pathologist Application

Speech Tablet Application - SLP Form

First Name

Last Name

Credentials

Address

City

State/Province

Zip/Postal

Country

Phone

Job Title

Practice/Facility

Name of Child

Are you currently providing speech therapy to this child?

Yes

Does the child have a formal diagnosis of childhood apraxia of speech (CAS) or suspected CAS identified in a speech-language evaluation report or current therapy summary?

Yes

With consideration that a CAS diagnosis requires an elicited speech sample, what are the specific speech characteristics or early developmental indicators of CAS that you observe in this child?

Would this child benefit from an iPad that is used more as a speech practice tablet or more as a communication device and why?

What do you estimate to be the severity of the child’s CAS or sCAS? (choose one)

How much of this child’s speech can currently be understood by an unfamiliar listener?

Does the child have another impairment or diagnosis that is primarily responsible for the communication difficulty?

Yes

Please explain.

How frequently do you provide therapy to this child?

Where do you provide therapy to this child?

Describe the child’s behavior and compliance with therapy.

Describe how the family is involved in your speech therapy & home follow through of your goals.

Describe your experience using an iPad.

Have you used an iPad or any other AAC device in therapy with this child?

Yes

Please describe this child's ability to access and use the device.

What suggestions do you have for this child for apps/communication tools to use on the iPad?

Describe how you will provide the family with assistance in learning how to use the iPad.

Describe in detail why you think this particular child should be provided with a speech tablet for speech practice or communication support.

Provide any supporting information that would indicate that this child and family would be good candidates for the program and will be able to learn and follow through with speech tablet usage.

Provide specific examples of how family involvement and support is sufficient to enable the speech tablet to be a useful tool for the child.

Is there any additional information you’d like to provide about this child/family?

Upload the child’s written speech-language evaluation report or detailed therapy summary report. (Please see above for instructions on what to upload here if you haven’t already.

Maximum upload size: 516MB

By signing below, I attest that the statements I have made above are accurate and true.

I agree

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