AT/AAC Learner Profile - EI/ECSE 2023-24
***Learner Profiles submitted after 5/1/24 will be addressed at the end of August of the following school year (2024-2025)***

IMPORTANT: Students must be enrolled at CRIS as regionally eligible before we can proceed with consultation. If not already enrolled, a CRIS Student Referral Form (link below) must have been submitted BEFORE you complete this AT/AAC Learner Profile.

CRIS Services Referral Form

This AT/AAC Learner Profile helps us get a more complete picture of your student by gathering information not included in the CRP Student Referral For
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Name of Student
Student Date of Birth
MM
/
DD
/
YYYY
In what county does the student receive services?
Clear selection
In which district/LEA does this student receive services? *
Under which eligibility does the child currently qualify for regional services? (check all that apply - must have at least one low incidence disability)
Name of person completing this form? *
Role/Position of person completing this form *
Email address of person completing this form? *
Name and role of contact person (if different from above)
Email address of contact person?
Which services does the child currently receive? *
Required
Medical diagnosis/diagnoses?
Additional Medical considerations (check all that apply)
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