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.
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
In what county does the 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)
Blind / Visually Impaired
Deaf or Hard of Hearing
Traumatic Brain Injury
Autism Spectrum Disorder
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?
Additional Medical considerations (check all that apply)
History of seizures
Degenerative medical condition
Which services does the child currently receive?
Speech and Language
Augmentative and Alternative Communication
Autism Specialist Consultation
Vision and/or Orientation & Mobility
Interpreter (non-English, or Sign Language)
Behavior Support Plan
What's your student's current seated positioning? (Wheelchair, Rifton Mobile, etc.)
Has your team conducted a SETT (Student, Environments, Tasks, Tools) Meeting?
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?
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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This form was created inside of Portland Public Schools.