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ASSISTIVE TECHNOLOGY GUIDESpecial Education Programs

Date: 5.25.2023

Building: Choose an item. Grade: Choose an item. District: HSE, #3005

Student’s Name: DOB: Gender: M ☐ F ☐Parent(s)/Guardian Name: Click here to enter text. Phone Number: Click here to enter text.

Address: City, State: Zip:

SLP:       Phone Number:       Email:      

OT:       Phone Number:       Email:      

TOR:       Phone Number:       Email:      

1. In which area(s) is the student having difficulty accessing the general education curriculum? Mechanics Of Writing/Written Expression Computer Access Organizing Hearing Communication Vision Reading

2. What is it we want the student to be able to do within the educational setting that he/she isn’t able to do because of the difficulty documented above and how is this impacting the student’s progress relative to The State Standards?      

3. Have we, as a collaborative team implemented the following to meet the student’s educational needs? Alternative Interventions Yes No Generally Available Technologies Yes No All Reasonable Available Accommodations Yes No Behavioral Interventions Yes No Instructional Techniques Yes No

Describe the interventions, including dates, length, and outcomes. Attach available documentation.      

4. Proceed to a case conference to address the need for an Assistive Technology assessment or other interventions.

Please attach the following items to the referral for the AT evaluation within the IIEP. 1. AT Consideration Guide 2. Current Psych Report The IEP is available on the computerized IEP Program 4. Completed Parent Input From for AT Assessment

Copies to: Director/Designee, Parents/Guardians, AT Coordinator, Student FileRev: 5.25.2023

Administration Office • 13485 Cumberland Road • Fishers, IN 46038Ph: 317.594.4100 • FAX: 317.594.4109 • Web site: www.hse.k12.in.us