AAC Referral Form
Should I Refer for an AAC Assessment? How do I know if a student could benefit from augmentative and alternative communication (AAC)? If you answer “no” to any of the referral questions below, or if you feel like the student would otherwise benefit from additional support with communication in order to make progress toward IEP goals and objectives, then the student may be a good candidate for augmentative and alternative communication (AAC).

Please complete the following referral form. Upon submission, answers will be automatically directed to KIPP Texas AAC lead and forwarded to the student's campus SLP and Special Education Coordinator/Lead. Verification of your submission along with a copy of the referral will be emailed to you for your records. A campus SLP will be in touch regarding next steps.

*SLPs - Please also use this form to flag any new student AAC needs. This may include initial referrals, students you intend to assess or monitor. This helps us plan ahead for our AAC procurement. Thanks!
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Referral Source
ARD committee request
*
Your relationship to the student *
*
Student Information
*
Grade *
KIPP NEXUS MIDDLE *

jyates@abilitieshouston.com 
morgan.jefferson-twitty@kipptexas.org 

AAC Referral Questions
Does the student use spoken language for at least three communication functions and purposes (e.g., requesting, commenting, asking questions, refusing/rejecting, social interaction)? *
Does the student initiate verbal communication independently? *
Is the student able to participate in all communication tasks expected of peers in the school, home, or community setting? *
Is the student able to consistently rely on spoken language for their all communication needs? *
Are you able to understand at least 70% of the student’s spoken language? *
(Follow-up question) If not, is the student becoming more comprehensible over time? *
Student is visually impaired and nonverbal and is need of an AAC evaluation.
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