Chippewa Hills School District Assistive Technology Request
Please fill in as much information as possible so a member of the MOISD Assistive Technology team can reach out to you to support assistive technology needs for a student. Once you have submitted this form, a MOISD Assistive Technology Team Member will reach out to you in 5 school days to address the request.
Referring Person's First and Last Name
Referring Person's Job Title
Contact Phone Number
Best Time to Contact Referring Person
Student's First and Last Name
Please check from the following options.
In Special Education Evaluation Process
What challenges or difficulties is the student having?
What activities does the student need assistance with performing?
What assistance has been tried and what were the results?
A copy of your responses will be emailed to the address you provided.
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