NCES Hearing, Vision, Speech, Language Request Form
Student's Name:
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Teacher's name:
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Student's grade:
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Please check all that apply:
Other:
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If articulation, language, fluency, or voice was checked--please give a brief description of how this is affecting the student in the classroom.
For example: The teachers and students are having a hard time understanding Joe's speech.
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Any additional comments:
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