OATECA Evaluation Request Information
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Email address
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Your email
Contact Person
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Best Contact Number
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Contact Email
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Student Name
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School District Name
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School Address (physical address, city, zip)
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Primary Disability
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Student's Date of Birth
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Student's Grade
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Primary area of concern (check all that apply)
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Reading
Math
Computer Access
Access to Curriculum
Communication
Writing
Hearing
Vision
Seating/Positioning
ADL's
Other
Other:
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Additional information regarding area of concern
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