Assistive Technology Consideration Checklist

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Student Name: *

School: *

Date: *

YYYY

Directions:

Use this form to consider the need for assistive technology (AT). If a child requires AT, document AT needs on the IEP.

Part I: Identify any area that is keeping the student from accomplishing IEP goals that reflect his/her abilities, or identify any area where the student is already using AT.

A. Motor Aspects of Writing

B. Computer Access

C. Composing Written Material

D. Communication

E. Reading

F. Learning/Studying

G. Math

H. Recreation

I. Activities of Daily Living

J. Mobility

K. Environmental Control

L. Position and Seating

M. Vision

N. Hearing

Other:

Part II: A. List the area(s) identified in Part I. Specify the task(s) the student is unable to do and the environment(s) where that task takes place.

Part II: B. Briefly describe any special strategies, accommodations or technology already being used

Part II: C. Is the student able to complete tasks at his/her ability with any special strategies, accommodations or technology already being used *

Yes - Current strategies are adequate. Consideration is complete.

Yes - The student's current use of AT is adequate. Consideration is complete. Document current use of AT on IEP.

No - Go to Part III.

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