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									  KNOWLEDGE AND SKILLS ACQUISITION (KASA)
             SUMMARY FORM FOR
CERTIFICATION IN SPEECH-LANGUAGE PATHOLOGY




        Knowledge and Skills Acquisition (KASA) Summary Form
           For Certification in Speech-Language Pathology
                               March, 2003
                                  KNOWLEDGE AND SKILLS ACQUISITION (KASA)
                                           SUMMARY FORM FOR
                                      SPEECH-LANGUAGE PATHOLOGY

                                                        Instructions for Use

The Knowledge and Skills Acquisition (KASA) form summarizes a student's acquisition of the knowledge and skills delineated in the Standards
for the Certificate of Clinical Competence (SCCC). Entries are made only upon acquisition of the knowledge or skill; thus the KASA is not an
evaluation, but only a record that a particular knowledge or skill has been acquired.

Required Documentation

1. Students from CAA-accredited programs (Refer to "Automatic Approval" language in Standard I. Degree) must submit the "Verification by
Program Director" page of the KASA when applying for certification.

2. All other applicants must submit the entire, completed document, including the "Verification by Program Director" page when applying for
certification.

Use of the KASA Form

1. The CFCC encourages programs to use the KASA to demonstrate compliance with accreditation standards related to preparing students to
meet ASHA certification requirements. However, programs may develop other documents to verify student's acquisition of knowledge and
skills.

2. For students who must submit the entire KASA, and for academic programs wishing to use the KASA as a tracking document, indicate with a
check mark in Column B whether each knowledge and skill was achieved. If a particular knowledge or skill was acquired through work
completed in a specific course or courses, the title and number of the course(s) should be entered in Column C. If the knowledge or skills were
acquired in clinical practicum, enter the title and number of the practicum in Column D. If the knowledge or skill was acquired through course
work and/or clinical practicum, and/or lab or research activities, there should be entries in all of the applicable columns: C, D, and/or E.

3. Students and programs using the KASA are advised to keep a copy in a safe place, should they need to provide information to the Council
For Clinical Certification at a later date (e.g., upon application for reinstatement).

4. CFCC encourages programs and students to periodically review the KASA (or other tracking documents developed by the program) to assist
students in determining knowledge and skills already acquired and those yet to be attained.
                                                                                              Knowledge And Skills Acquisition (KASA) Summary Form
                                                                                                 For Certification in Speech-Language Pathology


The KASA form is intended for use by the certification applicant during the graduate program to track the processes by which the knowledge and skills specified in the 2005 Stan
the KASA form at the beginning of graduate study, and update it at intervals throughout the graduate program and at the conclusion of the program.


The student, with input and monitoring of program faculty, must enter a check mark in column B as each of the knowledge and skills is acquired. It is expected that many entries
with some entries, as appropriate, in the "Other" (lab, research, etc.) columns. Please enter the course or practicum number and title and description of other applicable activity.


I. KNOWLEDGE AREAS

                   A                           B                                                     C

                                          Knowledge/
                                           Skill Met?
               Standards                    (check )                                       Course # and Title
Standard III-A. The applicant must
demonstrate knowledge of the
principles of:
    ● Biological sciences                x              BIOL 11900 Fund of Bio
    ● Physical sciences                  x              CHEM 12100 Princ of Chem, CHEM 12400 Exper Chem
    ● Mathematics                        x              MATH 10200 PreCalcus, MAT 124 Statistics
    ● Social/Behavioral sciences         x              PSHCY 10300 General Psych, PSYCH 32100 Abnormal Psych
Standard III-B. The applicant must
demonstrate knowledge of basic
human communication and
swallowing processes, including
their biological, neurological,
acoustic, psychological,
developmental, and linguistic and
cultural bases
● Basic Human Communication
Processes
  ● Biological                           x              SPPH 21200 Anat and Phsio of Speech and Hearing Mech
  ● Neurological                         x              PSYCH 31100 Behavioral Neuro, PSYCH 3300 Cognition
  ● Acoustic                             x              PHYS 1600 Physics of Sound, SLHS 6000 Speech Science

                                                                                    3
                                                                               January, 2003
                  A                           B                                                  C

                                         Knowledge/
                                           Skill Met?
              Standards                     (check )                                    Course # and Title
 ● Psychological                         x              PSYCH 20400 Developmental Psych
 ● Developmental/Lifespan                x              SPPH 21600 Normal Speech and Lang development
 ● Linguistic                            x              LING 23300 Intro to Linguistics
 ● Cultural                              x              SPPH 10900 Sign Language 1
● Swallowing Processes
 ● Biological                            x              SLHS5110 Clinical Theory and Practice
 ● Neurological                          x              SLHS 5292 Motor Sp/ Dysphagia
 ● Acoustic                              X              SLHS 5292 Motor Sp/Dysphagia
 ● Psychological                         x              SLHS 5292 Motor Sp/ Dysphagia
 ● Developmental/Lifespan                x              SLHS5110 Clinical Theory and Practice
 ● Linguistic                            x              SLHS 5292 Motor Sp/ Dysphagia
 ● Cultural                              x              SLHS 5110 Clinical Theory and Practice

Standard III-C. The applicant must
demonstrate knowledge of the
nature of speech, language, hearing,
and communication disorders and
differences and swallowing
disorders, including their etiologies,
characteristics,
anatomical/physiological, acoustic,
psychological, developmental, and
linguistic and cultural correlates.
Specific knowledge must be
demonstrated in the following areas:

Articulation
● Etiologies                             x              SPPH 22000 Artic and Phono Develop dis, SPPH 11010 Phonetics
● Characteristics                        x              SPPH 22000 Artic and Phono Develop dis, SPPH 11010 Phonetics
Fluency
● Etiologies                             x              SPPH 3200 Stuttering and Voice dis, SLHS 5362 Stutt tx and research
● Characteristics                        x              SPPH 3200 Stuttering and Voice dis, SLHS 5362 Stutt tx and research
Voice and resonance, including
respiration and phonation


                                                                                   4
                                                                              January, 2003
                    A                         B                                                C

                                         Knowledge/
                                           Skill Met?
               Standards                    (check )                                   Course # and Title
● Etiologies                             x            SPPH 3200 Stuttering and Voice dis
● Characteristics                        x            SPPH 3200 Stuttering and Voice dis
Receptive and expressive language
(phonology, morphology, syntax,
semantics, and pragmatics) in
speaking, listening, reading, writing,
and manual modalities
● Etiologies                             x            SPPH 2300 Child Lang Dis, SLHS 5242 Lang Dis: school age , SLHS 5612 Learn Dis
● Characteristics                        x            SPPH 45400 Sp and SLHS 5612 LD , SLHS 5612 Learn Dis
Hearing, including the impact on
speech and language
● Etiologies                             x            SPPH 2400 Basic Audiology
● Characteristics                        x            SPPH 24200 Aural Rehab
Swallowing (oral, pharyngeal,
esophageal, and related functions,
including oral function for feeding;
orofacial myofunction)
● Etiologies                             x            SLHS 5602 Communication Challenges Birth to 6, SLHS 5292 Motor Sp/ Dysphagia
● Characteristics                        x            SLHS 5602 Communication Challenges Birth to 6, SLHS 5292 Motor Sp/ Dysphagia
Cognitive aspects of communication
(attention, memory, sequencing,
problem-solving, executive
functioning
● Etiologies                             x            SPPH 35200 Dx and appraisal, SLHS 5282 ACQ Cog Dis, SPPH 37000 Clinican Prac 1
● Characteristics                        x            SPPH 35200 Dx and appraisal, SLHS 5282 ACQ Cog Dis, SPPH 37000 Clinican Prac 1
Social aspects of communication
(challenging behavior, ineffective
social skills, lack of communication
opportunities)
● Etiologies                             x            SPPH 45400 SP/ Lang Dis, SPPH 47200 Clinical Prac 2, SLHS 5100 Clinical TX and Prac


                                                                                5
                                                                           January, 2003
                 A                           B                                                C

                                        Knowledge/
                                          Skill Met?
              Standards                    (check )                                Course # and Title
● Characteristics                       x            PSYCH Psych of Adjust, SPPH 47200 Clinical Prac 2, SLHS 5100 Clinical TX and Prac
Communication modalities
(including oral, manual,
augmentative and alternative
communication techniques, and
assistive technologies)
● Characteristics                       x            SLHS 5272 Aug Altern Communication, SPPH 10900 Sign Lang
Standard III-D: The applicant must
possess knowledge of the principles
and methods of prevention,
assessment, and intervention for
people with communication and
swallowing disorders, including
consideration of
anatomical/physiological,
psychological, developmental, and
linguistic and cultural correlates of
the disorders.
Articulation
● Prevention                            x            SPPH 22000 Artic and Phono Develop dis, SHLS 5302 Phonological Disorders
● Assessment                            x            SPPH 22000 Artic and Phono Develop dis, SHLS 5302 Phonological Disorders
● Intervention                          x            SPPH 22000 Artic and Phono Develop dis, SHLS 5302 Phonological Disorders
Fluency
● Prevention                            x            SLHS 5362 Stuttering TX and Research, SPPH 3200 Stuttering and Voice dis
● Assessment                            x            SLHS 5362 Stuttering TX and Research, SPPH 3200 Stuttering and Voice dis
● Intervention                          x            SLHS 5362 Stuttering TX and Research, SPPH 3200 Stuttering and Voice dis
Voice and Resonance
● Prevention                            x            SLHS 5292 Motor Spch dis/ dysphagia , SPPH 3200 Stuttering and Voice dis
● Assessment                            x            SLHS 5292 Motor Spch dis/ dysphagia, SPPH 3200 Stuttering and Voice dis
● Intervention                          x            SLHS 5292 Motor Spch dis/ dysphagia, SPPH 3200 Stuttering and Voice dis

                                                                               6
                                                                          January, 2003
                    A                    B                                                 C

                                     Knowledge/
                                      Skill Met?
                 Standards             (check )                                    Course # and Title

Receptive and Expressive Language

● Prevention                         x             SLHS 5612 LD, SLHS 5252 Acq Adult lang Dis, 5282 Acq Cog Dis
● Assessment                         x             SLHS 5612 LD, SLHS 5252 Acq Adult lang Dis, 5282 Acq Cog Dis
● Intervention                       x             SLHS 5612 LD, SLHS 5252 Acq Adult lang Dis, 5282 Acq Cog Dis
Hearing, including the impact on
speech and language
● Prevention                         x             SPPH 2400 Basic Audiology, SPPH 24200 Aural Rehab, SPPH 10900 Sign Lang
● Assessment                         x             SPPH 2400 Basic Audiology, SPPH 24200 Aural Rehab, SPPH 10900 Sign Lang
● Intervention                       x             SPPH 2400 Basic Audiology, SPPH 24200 Aural Rehab, SPPH 10900 Sign Lang
Swallowing
● Prevention                         x             SLHS 5602 Communication Challenges Birth to 6, SLHS 5292 Motor Sp/ Dysphagia
● Assessment                         x             SLHS 5602 Communication Challenges Birth to 6, SLHS 5292 Motor Sp/ Dysphagia
● Intervention                       x             SLHS 5602 Communication Challenges Birth to 6, SLHS 5292 Motor Sp/ Dysphagia
Cognitive aspects of communication

● Prevention                         x             SLHS 5252 Acq Adult lang Dis, 5282 Acq Cog Dis
● Assessment                         x             SLHS 5252 Acq Adult lang Dis, 5282 Acq Cog Dis
● Intervention                       x             SLHS 5252 Acq Adult lang Dis, 5282 Acq Cog Dis
Social aspects of communication
● Prevention                         x             SPPH 45400 SP/ Lang Dis, SPPH 47200 Clinical Prac 2, SLHS 5100 Clinical TX and Prac
● Assessment                         x             SPPH 45400 SP/ Lang Dis, SPPH 47200 Clinical Prac 2, SLHS 5100 Clinical TX and Prac
● Intervention                       x             SPPH 45400 SP/ Lang Dis, SPPH 47200 Clinical Prac 2, SLHS 5100 Clinical TX and Prac
Communication Modalities
● (Prevention not applicable)
● Assessment                         x             SLHS 5272 Aug Altern Communication, SPPH 10900 Sign Lang
● Intervention                       x             SLHS 5272 Aug Altern Communication, SPPH 10900 Sign Lang


                                                                             7
                                                                        January, 2003
                  A                         B                           C

                                        Knowledge/
                                         Skill Met?
               Standards                  (check )              Course # and Title
Standard IV-G: The applicant for
certification must complete a
program of study that includes
supervised clinical experiences
sufficient in breadth and depth to
achieve the following skills
outcomes (in addition to clinical
experiences, skills may be
demonstrated through successful
performance on academic course
work and examinations, independent
projects, or other appropriate
alternative methods):
1. Evaluation (must include all skill
outcomes listed in a-g below for
each of the 9 major areas)
a. Conduct screening and
prevention procedures (including
prevention activities)

b. Collect case history information
and integrate information from
clients/patients, family, caregivers,
teachers, relevant others, and other
professionals

c. Select and administer appropriate
evaluation procedures, such as
behavioral observations
nonstandardized and standardized
tests, and instrumental procedures
d. Adapt evaluation procedures to
meet client/patient needs


                                                           8
                                                      January, 2003
                  A                          B                                              C

                                         Knowledge/
                                          Skill Met?
              Standards                    (check )                                Course # and Title

e. Interpret, integrate, and
synthesize all information to develop
diagnoses and make appropriate
recommendations for intervention
f. Complete administrative and
reporting functions necessary to
support evaluation
g. Refer clients/patients for
appropriate services
● Articulation                           x             SLHS 5898 PRAC 1-SP/LANG/LRN/INTRV
● Fluency                                x             SLHS 5878 PRAC 1-SP/LANG/LRN/APPRA
● Voice and resonance, including
respiration and phonation
● Receptive and expressive language
(phonology, morphology, syntax,
semantics, and pragmatics) in
speaking, listening, reading, writing,
and manual modalities                    x             SLHS 5898 PRAC 1-SP/LANG/LRN/INTRV, SLHS 5612 LD, SLHS 5612 LD
● Hearing, including the impact on
speech and language                      x             SLHS 5878 PRAC 1-SP/LANG/LRN/APPRA
● Swallowing (oral, pharyngeal,
esophageal, and related functions,
including oral function for feeding;
orofacial myofunction)                   x             SLHS 5878 PRAC 1-SP/LANG/LRN/APPRA
● Cognitive aspects of communication
(attention, memory, sequencing,
problem-solving, executive functioning) x              SLHS 5898 PRAC 1-SP/LANG/LRN/INTRV
● Social aspects of communication
(including challenging behavior,
ineffective social skills, lack of
communication opportunities)            x              SLHS 5898 PRAC 1-SP/LANG/LRN/INTRV



                                                                              9
                                                                         January, 2003
                  A                          B                                              C

                                         Knowledge/
                                          Skill Met?
               Standards                   (check )                                Course # and Title
● Communication modalities (including
oral, manual, augmentative, and
alternative communication techniques
and assistive technologies)             x              SLHS 5898 PRAC 1-SP/LANG/LRN/INTRV
2. Intervention (must include all skill
outcomes listed in a-g below for
each of the 9 major areas)

a. Develop setting-appropriate
intervention plans with measurable
and achievable goals that meet
clients'/patients' needs. Collaborate
with clients/patients and relevant
others in the planning process

b. Implement intervention plans
(involve clients/patients and relevant
others in the intervention process)
c. Select or develop and use
appropriate materials and
instrumentation for prevention and
intervention
d. Measure and evaluate
clients'/patients' performance and
progress
e. Modify intervention plans,
strategies, materials, or
instrumentation as appropriate to
meet the needs of clients/patients
f. Complete administrative and
reporting functions necessary to
support intervention



                                                                              10
                                                                         January, 2003
                   A                         B                                              C

                                         Knowledge/
                                          Skill Met?
              Standards                    (check )                                Course # and Title

g. Identify and refer clients/patients
for services as appropriate
● Articulation                           x             SLHS 5898 PRAC 1-SP/LANG/LRN/INTRV
● Fluency                                x             SLHS 5878 PRAC 1-SP/LANG/LRN/APPRA
● Voice and resonance
● Receptive and expressive language      x             SLHS 5898 PRAC 1-SP/LANG/LRN/INTRV
● Hearing, including the impact on
speech and language                      x             SLHS 5898 PRAC 1-SP/LANG/LRN/INTRV
● Swallowing                             x             SLHS 5292 Motor Sp/ Dysphagia
● Cognitive aspects of communication x                 SLHS 5898 PRAC 1-SP/LANG/LRN/INTRV
● Social aspects of communication    x                 SLHS 5898 PRAC 1-SP/LANG/LRN/INTRV
● Communication modalities           x                 SLHS 5898 PRAC 1-SP/LANG/LRN/INTRV

3. Interaction and Personal Qualities
a. Communicate effectively,
recognizing the needs, values,
preferred mode of communication, and
cultural/linguistic background of the
client/patient, family, caregivers, and
relevant others.                        x              SLHS 5898 PRAC 1-SP/LANG/LRN/INTRV
b. Collaborate with other professionals
in case management.                                    SLHS 5898 PRAC 1-SP/LANG/LRN/INTRV, SLHS 5878 PRAC 1-SP/LANG/LRN/APPRA
c. Provide counseling regarding
communication and swallowing
disorders to clients/patients, family,
caregivers, and relevant others.                       SLHS 5898 PRAC 1-SP/LANG/LRN/INTRV, SLHS 5878 PRAC 1-SP/LANG/LRN/APPRA
d. Adhere to the ASHA Code of Ethics
and behave professionally.                             PERFORMANCE EVALUATION OF PROFESSIONAL SKILLS (PEPS)




                                                                              11
                                                                         January, 2003
 mmary Form
athology


and skills specified in the 2005 Standards for the CCC are being acquired. Each student should review
ogram.


red. It is expected that many entries will appear in the course work and the clinical practicum columns,
scription of other applicable activity.




                        How Achieved?
                             D                                                     E


                                                                 Other (e.g. labs, research) (Include
              Practicum Experiences # and Title                        description of activity)




                                                             Organisms and Evolution Lab

                                                             PSYCH 33100 Cognitive Psych Lab




                                                             PSYCH 33100 Cognitive Psych Lab
                                                             SLHS 6000 Speech Science Lab

                                                                                          12
                                                                                     January, 2003
                 How Achieved?
                      D                                     E


                                           Other (e.g. labs, research) (Include
       Practicum Experiences # and Title         description of activity)




SLHS 5898 Intervention
SLHS 5898 Intervention

SLHS 5878 Stuttering DX
SLHS 5878 Stuttering DX




                                                                  13
                                                             January, 2003
                  How Achieved?
                       D                                         E


                                               Other (e.g. labs, research) (Include
        Practicum Experiences # and Title            description of activity)




Externship and Summit Speech School
Externship and Summit Speech School         Hearing Screenings




SLHS 5898 Writer's Workshop
SLHS 5898 Writer's Workshop




SLHS 5898 Individual client


                                                                      14
                                                                 January, 2003
                 How Achieved?
                      D                                         E


                                               Other (e.g. labs, research) (Include
       Practicum Experiences # and Title             description of activity)
SLHS 5898 Individual client




AAC Camp, Externship at Summit Speech School




SLHS 5989 Individual Client
SLHS 5989 Individual Client


SLHS 5878 Stuttering DX
SLHS 5878 Stuttering DX
SLHS 5878 Stuttering DX




                                                                      15
                                                                 January, 2003
                  How Achieved?
                       D                                        E


                                               Other (e.g. labs, research) (Include
        Practicum Experiences # and Title            description of activity)



SLHS 5898 Writer's Workshop
SLHS 5898 Writer's Workshop
SLHS 5898 Writer's Workshop



Hearing Screenings
Externship and Summit Speech School
Externship and Summit Speech School




SLHS 5898 Individual client
SLHS 5898 Individual client
SLHS 5898 Individual client


SLHS 5898 Individual client
SLHS 5898 Individual client
SLHS 5898 Individual client



AAC Camp, Externship at Summit Speech School
AAC Camp, Externship at Summit Speech School


                                                                      16
                                                                 January, 2003
        How Achieved?
             D                                       E


                                    Other (e.g. labs, research) (Include
Practicum Experiences # and Title         description of activity)




                                                           17
                                                      January, 2003
                    How Achieved?
                         D                                        E


                                                Other (e.g. labs, research) (Include
         Practicum Experiences # and Title            description of activity)




Individual Client
Stuttering DX




Individual Client

Stuttering DX                                Hearing Screenings




Stuttering DX



Writers Workshop, Individual Client



Writers Workshop, Individual Client



                                                                       18
                                                                  January, 2003
                How Achieved?
                     D                                          E


                                               Other (e.g. labs, research) (Include
       Practicum Experiences # and Title             description of activity)




Externship at Summit Speech School, AAC Camp




                                                                      19
                                                                 January, 2003
                    How Achieved?
                         D                                    E


                                             Other (e.g. labs, research) (Include
         Practicum Experiences # and Title         description of activity)



Individual Client
Stuttering DX

Writers Workshop, Individual Client




Writers Workshop, Individual Client
Writers Workshop, Individual Client
Writers Workshop, Individual Client




Writers Workshop, Individual Client

Stuttering DX, Writer's Workshop



Writers Workshop, Individual Client

See PEPS Form




                                                                    20
                                                               January, 2003
                                            Knowledge and Skills Acquisition (KASA) Summary Form
                                               For Certification in Speech-Language Pathology

                                                          Verification by Program Director
The applicant for certification:
 □ Yes      □ No      Has a master's or doctoral degree. A minimum of 75 semester credit hours were completed in a course of study addressing the
                      knowledge and skills pertinent to the field of speech-language pathology (Std. I)
 □ Yes      □ No      Initiated and completed all graduate course work and graduate clinical practicum in an institution whose program was accredited
                      by the CAA (Std. I)
 □ Yes       □ No     Has completed a program of study (a minimum of 75 semester credit hours overall, including at least 36 at the graduate level)
                      that includes academic course work sufficient in depth and breadth to achieve the specified knowledge outcomes (Std. III-A,B,C)
 □ Yes       □ No     Possesses knowledge of the principles and methods of prevention, assessment and intervention for people with communication
                      and swallowing disorders (Std. III-D)
 □ Yes       □ No     Has demonstrated knowledge of standards of ethical conduct (Std. III-E)
 □ Yes       □ No     Has knowledge of processes used in research and the integration of research principles into evidence-based clinical practice
                      (Std. III-F)
 □ Yes       □ No     Has demonstrated knowledge of contemporary professional issues (Std. III-G)
 □ Yes       □ No     Has demonstrated knowledge about certification, specialty recognition, licensure, and other relevant professional credentials
                      (Std.III-H)
 □ Yes       □ No     Has completed a curriculum of academic and clinical education that follows an appropriate sequence of learning sufficient to
                      achieve the skills outcomes in Standard IV-G (Std. IV-A)
 □ Yes       □ No     Possesses skill in oral and written and other forms of communication sufficient for entry into professional practice (Std. IV-B)
 □ Yes       □ No     Has completed a minimum of 400 clock hours of supervised clinical experience in the practice of speech-language pathology,
                      including 25 hours in clinical observation and 375 hours in direct client/patient contact (Std. IV-C)
 □ Yes       □ No     Has completed at least 325 clock hours while engaged in graduate study (Std. IV-D)
 □ Yes       □ No     Has been supervised by individuals holding a current ASHA Certificate of Clinical Competence in the appropriate area of
                      practice. The amount of supervision was appropriate to the student's level of knowledge, experience, and competence and the
                      supervision was sufficient to ensure the welfare of the client/patient populations (Std. IV-E)
 □ Yes       □ No     Has gained knowledge of and experience with individuals from culturally/linguistically diverse backgrounds and with client/patient
                      populations across the life span (Std. IV-F)
 □ Yes       □ No     The applicant has met the education program's requirements for demonstrating satisfactory performance through ongoing
                      formative assessment of knowledge and skills. (Std. V-A)

   The program director verifies that the student met each standard and has successfully met the education program's requirements for demonstrating
   satisfactory performance through ongoing assessment of knowledge and skills.

_____________________________________________________                         _____________________________________________________
Name                                                                          Program
_____________________________________________________
Title
_____________________________________________________                         ___________________________________
Signature                                                                     Date


                                                                              11
                                                                         January, 2003

								
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