Request for at Consultation

20_ _ - 20_ _ Request for Assistive Technology Consultation

The Assistive Technology (AT) Process  The student has an unmet need to access the curriculum. Conventional strategies have been tried. More support for the student is needed.  Team meets and identifies areas of student need and considers possible assistive technology devices or services.  AT Consideration checklists (available at http://www.wiu.k12.pa.us ) are used to review past and potential interventions. o Past or current tools and interventions are noted and described in terms of their outcomes.  If the team determines that the further assistance of a WIU Assistive Technology Coordinator is required, a Request for Assistive Technology Consultation packet is completed by the team and forwarded to the school district’s special education liaison for review. o AT Coordinator reviews information from the liaison, communicates with various team members, and makes site visits (as appropriate) o Recommendations are shared with the team using the Assistive Technology Action Plan.  Team members meet to review the recommendations, identify available resources, clarify needed supports, outline action steps, and agree to responsibilities for action steps.  Team members meet to discuss the outcomes of trials and update the IEP/IFSP, if warranted.

Estimated Timelines when a Request for Assistive Technology Consultation is Used District Intermediate Unit District  Request for Support  Request received and  Recommendations  Assistive  Trials and training completed by team and forwarded reviewed are made and forwarded to Technology Action Plan conducted, as needed to liaison  Consultation occurs the team via the Assistive is reviewed and  District team meets  Request reviewed by the via phone, email, or onsite Technology Action Plan completed by district to review outcomes of special education liaison/LEA visit team members trial or discuss  Signed Request for AT recommendations Consultation and supporting  IEP developed or documentation are sent to the revised, as needed WIU Assistive Tech Coordinator 10 days 30 days 10 days 10 days

Please mail this completed form and supporting documentation to: Kristen Tachoir Westmoreland Intermediate Unit #7 102 Equity Drive Greensburg, PA 15601-7190 Westmoreland Intermediate Unit #7 AT Request for Support.doc September, 2010 This packet must be completed in print/type by the Building Team Contact and reviewed by the District Liaison/LEA upon packet completion.

Student : Date of Birth (Age): K-Age (Kindergarten/EI only): District/School/Grade/Support Type: District of Residence (if different): Building Team Contact Name: Contact’s Contact’s Email: Contact’s Phone: Fax:

Student & Team Availability: Please indicate the days and time periods that the student and team members are available for onsite visits (Check all that apply) Monday AM PM Tuesday AM PM Wednesday AM PM Thursday AM PM Friday AM PM Special scheduling concerns:

** Incomplete requests or those that have not been reviewed by the school district liaison will be returned. ** Signed, completed requests will only be processed by the AT Coordinator after all documentation has been received.

Reviewed by (REQUIRED):

Liaison/LEA Signature Date of Review

For electronic submission only: Checking this box in lieu of a signature indicates that this request has been approved by the designated school district liaison. The reviewer’s name and review date must be indicated on the appropriate lines above.

Westmoreland Intermediate Unit #7 AT Request for Support.doc September, 2010 Team Parents/Guardians, School District Liaison, Charter/APS/DART Administrator, Building Principal, Psychologist, General Education Teacher, Special Education Teacher, Paraeducator, Building Technology Contact, Speech-Language Pathologist, Hearing/Vision Teacher, OTR/COTA/PT, Student, Other Name Team Role Email Phone Parent General Educator Special Educator Principal

The following documents are attached with this request: Current Evaluation Report Date: ______

Current IEP/IFSP/SA Date: ______

Portfolio/Samples of Student-generated work (for requests involving writing Please write dates and pertinent comments on each sample. and/or written expression – grammar, spelling, organization) Diagnostic Reading Assessment (for requests involving reading/writing) Date: ______Assistive Technology Considerations checklist Date: ______(available at: http://wiu.k12.pa.us) Other (Please Specify) Date: ______

What is the core reading program? What supplemental reading programs are used? Minutes of reading instruction per day:

Westmoreland Intermediate Unit #7 AT Request for Support.doc September, 2010 The SETT Framework – Part I Collaborative Consideration of Student Need for Assistive Technology Devices and Services

Student : Date: Complete this section as a team. Clarify potential or existing barriers to student progress or AT implementation. Student Environment Tasks Tools What are the specific areas of concern? In which settings are the needs noted? What must the student do to meet lesson or What no-tech, low-tech, and high-tech Include the student’s current level of Who teaches or supports the student in IEP goals? What do peers do in comparison? tools have been used or considered? achievement and the student’s strengths, these settings? Include information related Identify the tasks the student needs to do or Please include strategies that may be needs, and interests. to anyone who is around the student or learn to do that are currently difficult or listed under specially designed anything that is provided to the student. impossible for the student to do at the instruction. expected level of independence.

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© Joy Zabala, 2001. PERMISSION GRANTED TO USE IF CREDITS ARE RETAINED. Please provide feedback on effectiveness and suggestions for modifications/revisions by email to [email protected] Westmoreland Intermediate Unit #7 AT Request for Support.doc September, 2010 Modified by Montgomery County, MD Public Schools Assistive Technology Team, Allegheny Intermediate Unit #3, Westmoreland Intermediate Unit #7

Westmoreland Intermediate Unit #7 AT Request for Support.doc September, 2010 Areas of Concern (Check all that apply): Expressive Communication Mobility Sensory Needs – Hearing Receptive Communication Organization Sensory Needs – Vision Computer Access Reading Writing – Composition Mathematics Seating & Positioning Writing – Fine Motor

Please print or type: Based on the collaborative review, what educational concerns does the team hope to have addressed by this assistive technology consultation? What are the desired outcomes?

What supports are currently available to the student and team in terms of assistive technology? Describe pertinent strategies, devices, and personnel. Which strategies from the Assistive Technology Considerations checklists have been considered or attempted?

Additional information or comments:

Westmoreland Intermediate Unit #7 AT Request for Support.doc September, 2010