AT/AAC Learner Profile - EI/ECSE 2020-21
***Learner Profiles submitted after 5/17/21 will be be addressed at the end of August the following school year (2021-2022)***

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

https://www.crporegon.org/cms/lib/OR01928264/Centricity/Domain/24/CRP%20Referral%202018%20v1_5a.pdf

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 Form.
Name of Student
Student Date of Birth
MM
/
DD
/
YYYY
In what county does the student receive services?
Clear selection
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?
Email address of person completing this form?
Name of contact person (if different from above)
Email address of contact person?
Medical diagnosis/diagnoses?
Additional Medical considerations (check all that apply)
Which services does the child currently receive?
What's your student's current seated positioning? (Wheelchair, Rifton Mobile, etc.)
Has your team conducted a SETT (Student, Environments, Tasks, Tools) Meeting?
Clear selection
Describe the specific tasks, activities, or routines that the student needs to perform that he/she is currently unable to do.
Describe the environments in which these tasks, activities, or routines are to be performed (e.g., classroom, library, circle, playground, etc.)
Does the student have IFSP goals related to the tasks, activities, or routines listed above?
Clear selection
Describe what AT tools and strategies have already been tried with the student.
What were the outcomes of those interventions?
To help us motivate your student, please give some examples of items and activities that the student likes and dislikes. (Be specific. Rather than saying "nursery rhymes," list specific favorites.
Is there any additional information you can share that would assist us in preparing our consultative support?
If a visit is scheduled, where would we be providing consultation?
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