Recommendation To Test Hearing printable pdf download

Recommendation To Test Hearing

South Bend Community School Corporation

Special Education Services

Recommendation to Test Hearing

Date:_________________

Student’s Name: ______________________________ School: ___________________________

Dear Parent/Guardian:

Indiana state law requires that schools screen the hearing of all students in grades 1, 4, 7, and 10. Students in

other grades may be screened upon request from school staff or parents. For students who did not pass this initial

screening, typically another screening is done to verify the results. Results of this second screening indicate that

your child needs a more thorough hearing test (called a threshold test).

A hearing (threshold) test under earphones uses pure tones (a subjective measure telling at what level your child

hears low through high frequency sounds/pitches) and may also include speech and impedance testing (an

objective measure looking at middle ear function).

We recommend you contact your family physician for a possible referral to an audiologist. It is important that we

receive a copy of test results to make sure we are monitoring your child’s hearing status in school. Results of any

medical exam and audiological evaluations should be returned to: Sharon Hirstein, Educational Audiologist,

Monroe Primary Center, 312 Donmoyer Ave., South Bend, IN 46614, School Fax: 574-231-5834.

If you have any questions or concerns, please call.

Thank you for your cooperation.

_____________________________________________________ Phone __________________

Speech Language Pathologist

8/19/12

Recommendation To Test Hearing