Your name
Your Email
Last 4 Of SSN
Date
E-Signature
I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.
Acute: 0★★★★−
Rehab: 0★★★★−
Inpatient: 0★★★★−
Outpatient: 0★★★★−
Home Health: 0★★★★−
SNF: 0★★★★−
Schools: 0★★★★−
Assessments: 0★★★★−
Augmentative Communication: 0★★★★−
Computer-based Treatment/Adaptive Microswitches: 0★★★★−
Feeding Disorders: 0★★★★−
Cleft Palate: 0★★★★−
Cognitive Rehab: 0★★★★−
Coma Stimulation: 0★★★★−
CVA / Stroke Rehab: 0★★★★−
Dysphagia: 0★★★★−
Fluency / Stuttering: 0★★★★−
Head Injury: 0★★★★−
Hearing Impaired: 0★★★★−
Laryngectomy: 0★★★★−
Neurological: 0★★★★−
Voice: 0★★★★−
Cerebral Palsy: 0★★★★−
Early Intervention: 0★★★★−
Learning Language Disabilities: 0★★★★−
Intellectual/Developmental Disabilities: 0★★★★−
NDT for Speech: 0★★★★−
Accent Reduction: 0★★★★−
Aural Rehabilitation / Speech Reading: 0★★★★−
Biofeedback-EMG: 0★★★★−
Cognitive Assessment: 0★★★★−
Co-Treatment with OT: 0★★★★−
Co-Treatment with PT: 0★★★★−
Family Education: 0★★★★−
Group Activities: 0★★★★−
In-service Education: 0★★★★−
Myofunctional Therapies: 0★★★★−
Prosthetics - Cleft Palate: 0★★★★−
Rehab Feeding Group: 0★★★★−
Sign Language: 0★★★★−
Tracheostomy: 0★★★★−
Ventilator: 0★★★★−
Videofluoroscopy: 0★★★★−
FEEST: 0★★★★−
Electronic Documentation: 0★★★★−
List Types (Electronic Documentation Systems):
Newborn (birth–30 days): 0★★★★−
Infant (30 days–1 year): 0★★★★−
Toddler (1–3 years): 0★★★★−
Preschooler (3–5 years): 0★★★★−
School Age (5–12 years): 0★★★★−
Adolescents (12–18 years): 0★★★★−
Young Adults (18–39 years): 0★★★★−
Middle Adults (39–64 years): 0★★★★−
Older Adults (64+ years): 0★★★★−
