This Speech and Language Referral Checklist is intended to help child care professionals identify children who may benefit from an assessment of their communication development by a Speech-Language Pathologist. If a child is already known to Niagara Children’s Centre, you do not need to complete a Speech and Language Referral Checklist.

To find out more information, check out the Niagara Children’s Centre Speech and Language Referral Checklist Overview & Instructions for QCCN.

Speech and Language Referral Checklist Consent Forms are available in
English: pdf or fillable pdf
French: pdf or fillable pdf

Educators may use the Speech & Language Tracking Sheet or the DPS & Speech and Language Tracking Sheet

Niagara Children’s Centre Speech and Language Referral Checklists
Complete ONE age category per child: choose the category that the child has most recently reached.

By 6 Months - EnglishFrench

By 2 Years - EnglishFrench

By 9 Months - EnglishFrench

By 2.5 Years - EnglishFrench

By 12 Months - EnglishFrench

By 3 Years - EnglishFrench

By 15 Months - EnglishFrench

By 3.5 Years - EnglishFrench

By 18 Months - EnglishFrench

By 4 Years - EnglishFrench

Niagara Children’s Centre Speech and Language Referral Form for QCCN - EnglishFrench

Niagara Children’s Centre Speech and Language Referral Pathways for QCCN has further information for referrals and includes the reminder that all children must be referred by August 31st prior to starting year one kindergarten. It is also available in French.

Niagara Children’s Centre Speech and Language Referrals: Frequently Asked Questions from the Child Care Community, in English or French