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AT Help Ticket
Use this form for AT Team support or to request AT purchase and/or acquisition of AT device(s). Do not include identifiable information (e.g., birthday, first and last name) on this form or in uploaded files.
For use by GFPS staff only. If the form is left open for a prolonged period, it may time out and result in lost information. Therefore, please review the form requirements ahead of time (e.g., data) and gather all necessary information ahead of time.
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Today's Date
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MM
/
DD
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YYYY
What school does the student attend?
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Your answer
Provide student initials and ID number
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Your answer
I am requesting support with
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A student's need(s) (i.e. Trial: iPad, AAC app, extensions, switch, eReader pens, etc.)
Purchase of AT device (s)
Other (e.g., consult, new student to district w/ AT listed, follow up on device request)
Add cowriter and/or snap and read
My student's needs(s)
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Handwriting
Reading
Written Expression
Math
Communication
Mobility
Seating and Positioning
Vision
Hearing
Computer Access
Recreation
Self-Care
Other
Required
What AT device(s) are you requesting? IF you are requesting purchase please provide a link to ordering information and estimated cost of each.
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Your answer
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