COMMUNICATION PROFILE QUESTIONNAIRE

STUDENT/CHILD'S NAME: 
 

AGE:
 

ETIOLOGY:
 

PERSON WORKING WITH STUDENT/CHILD:
 

1. How does your student or child communicate he or she is happy?
 

2. How does your student or child communicate he or she is sad/unhappy?
 

3. How does your student or child communicate he or she would like "more?"
 

4.  How does your student or child communicate he or she is uncomfortable or ill?
 

5.  How does your student or child communicate he or she is hungry, needs to go to the bathroom, etc.?
 

6.  How does your student or child communicate he or she is anticipating an activity?
 

7.  What communication system does your student or child utilize at home? (e.g., gestures, ASL, voice, AAC, etc.)
 

8.  What communication system does your student or child utilize at school? (e.g., gestures, ASL, voice, AAC, etc.)
 

9. Does your student or child initiate a communicative interaction at home or school? If so how?
 

10. Who does your student or child communicate most freely? (e.g., Siblings, Parents, Peers, etc)
 

11. What is your student's or child's most favorite activity? Explain why you believe this is so.
 

12. What is your student's or child's least favorite activity? Explain why you believe this is so.
 

13. How does your student or child react to an unfamiliar person or object?
 

14. How does your student or child react to a familiar person or object?