Audiological Assistance or FM Support for 2018-19
Please complete the requested information in order to assist the audiologist to effectively address your request. Please note that Audiological support provided by the MRP only covers the FM system and its components. Any malfunctions of the student's personal hearing aid(s) or cochlear implant(s) need to be addressed by the student's personal audiologist.
Best practice is that a student follow-up with his/her personal audiologist on a yearly basis for a hearing test and hearing aid check-up.
Please indicate who is making the referral.
Contact name if different from referring individual.
Contact e-mail address if different from referring individual.
Deaf/Hard of Hearing educator assigned to student
Classroom teacher's name.
Classroom teacher's email address if different from referring individual.
Please provide information on the student needing assistance.
Young Adult Program
What type of assistance are you requesting?
Newly identified student: team is requesting FM system
Student reports a problem with the FM system.
Student needs more batteries for the FM system.
Student's ear mold is damaged.
A component of the FM system is lost.
Student has new hearing aid or cochlear implant.
Summer School or ESY Use Request
Change of Student Status
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