Assistive Technology Consideration Checklist (Responses)
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FormEmailer StatusTimestampStudent Name:School:Date:Part I: Identify any area that is keeping the student from accomplishing IEP goals that reflect his/her abilities, or identify any area where the student is already using AT.Part II: A. List the area(s) identified in Part I. Specify the task(s) the student is unable to do and the environment(s) where that task takes place.Part II: B. Briefly describe any special strategies, accommodations or technology already being usedPart II: C. Is the student able to complete tasks at his/her ability with any special strategies, accommodations or technology already being usedPart III. Select one of the following an proceed as prescribed.AT may be required. The IEP team determines that additional information is needed and will conduct additional AT screening (may include additional observations, informal assessment or trials of AT devices and strategies) or refer for AT assessment by _________. Record this statement on the IEP. Comments:Form Completed by:Please enter email(s) to which you would like to send the information entered on this form
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Email sent7/30/2013 9:18:21testtest7/30/2013Yes - The student's current use of AT is adequate. Consideration is complete. Document current use of AT on IEP. testkurtisbroeg@williamsburg.k12.ia.us
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Email sent11/20/2013 11:54:45BettyBrown11/20/2013A. Motor Aspects of Writing, C. Composing Written MaterialNote taking, completing written workNoneNo - Go to Part III.AT may be required. The IEP team determines that additional information is needed and will conduct additional AT screening (may include additional observations, informal assessment or trials of AT devices and strategies) or refer for AT assessment. 12/20/2013Heidi petschkeHpetschke@therabilities.com
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6/25/2016 20:02:02LukeReynolds3/13/2003D. CommunicationNo - Go to Part III.AT may be required. The IEP team determines that additional information is needed and will conduct additional AT screening (may include additional observations, informal assessment or trials of AT devices and strategies) or refer for AT assessment. 1/13/2017Lisa R.skyluke1204@yahoo.com
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