Home About Us Meet the Team Our Research Recent Talks & Papers Current Studies Science + Language Intervention Summer Camp Artificial Grammar Study Book Reading Study SLP Survey For Parents Research Participation Community Language Screenings Outside Resources For Clinicians Infographics, Slides, and Links Ways to Get Involved Ask a Clinical Practice Question Survey about Dose in SLP Services to Children 3-7 For Students Employment Opportunities Contact Us General Contact Form Parent Contact Form Ask a Clinical Practice Question Links Language Research Registry Sister Labs at UD UD’s Speech-Language Hearing Clinic Outside Resources for Parents Parent Contact Form Let us know if you are interested in learning more or participating in our studies! Parent Contact Form If you are human, leave this field blank. Your Name * Age of Child 1 * Name of Child 1 Your Relationship to Child 1 * Parent Grandparent Other family member Legal Guardian Other Your Relationship to Child 1 Would you like to provide information about a second child? Yes No Age of Child 2 Name of Child 2 Your Relationship to Child 2 Parent Grandparent Other family member Legal Guardian Other Your Relationship to Child 2 Would you like to provide information about a third child? Yes No Age of Child 3 Name of Child 3 Your Relationship to Child 3 Parent Grandparent Other family member Legal Guardian Other Your Relationship to Child 3 Your Email Address * Your Phone Number What is the best way to contact you? Email Phone call Text What is the best time to contact you ? Examples: "weekday evenings" or "late morning/early afternoon" Does your child speak or hear any languages other than English? * Yes No If yes, which language(s) does your child hear or speak? Please describe how much and when your child uses a language other than English. Examples: "Talks to grandma in Spanish once in a while" or "Uses English half the time, French half the time" Does your child combine words (use more than one word in a sentence)? How often? My child uses single words Combines words sometimes Combines words all the time I'm not sure Which of the following is your child more likely to say? "Mommy kitchen, I think." "I think that Mommy is in the kitchen." "Mommy go kitchen." I'm not sure Which of the following is your child more likely to say? "He wondered why the kite flew." "Him kite fly?" "He wonder the kite flew." I'm not sure Does your child currently receive special education or early intervention services for speech or language difficulties through their school or through a clinic? Yes No I'm not sure If yes, please describe why your child is receiving services and what kind of goals they are working on. Has anyone ever told you that your child might have autism, a hearing impairment, intellectual disability, or any other disability ? Yes No I prefer not to answer If you feel comfortable doing so, please tell us about your child's diagnoses. Which days and times would be most convenient for you and your child to be seen for a study? Appointments typically last about an hour. Is there anything else you'd like to let us know about your child, their language abilities, or any special scheduling considerations? Thank you, we will get in touch soon.