Teacher Verification of IEP Review
*By signing this form you agree that the Speech-Language Pathologist provided you with both a written
and verbal explanation of the speech and language services for the following students in your classroom.
SCHOOL:__________________________________________________________
SPEECH-LANGUAGE THERAPIST:________________________________
[*including but not limited to - disability, minutes, classroom and/or testing accommodation, IEP goals,
and other relevant sections of ARD paperwork]
Teacher Name
Student Name
Date
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