Assistive Technology Consideration Checklist

Figure 1
Assistive Technology Consideration Checklist
Page
of
Student Name: ___________________________________
School: ____________________________________
Date: ____________________________________
Directions: Use this form to consider the need for assistive technology (AT). If a child requires AT, document AT needs on the IEP
Part I. Identify any area that is keeping the student from accomplishing IEP goals that reflect his/her abilities, or identify any area
Was 1 or more area identified?
where the student is already using AT.
⎯⎯⎯→
A. Motor Aspects of Writing
F. Learning/Studying
K. Environmental Control
Yes - Go to Part II.
B. Computer Access
G. Math
L Positioning and Seating
C. Composing Written Material
H Recreation
M Vision
No – Consideration is complete.
D. Communication
I. Activities of Daily Living
N. Hearing
E. Reading
J. Mobility
O. Other: _________
Part II.
B. Briefly list or describe any special strategies, accommodations or
C. Is the student able to complete tasks
A List the area(s) identified in Part I. Specify the
at his/her ability with any special
technology already being used.
⎯⎯⎯→
task(s) the student is unable to do and the
strategies, accommodations or
technology already being used?
environment(s) where that task takes place. ⎯⎯→
Yes - Current strategies are adequate.
Consideration is complete.
Yes - The student’s current use of AT
is adequate. Consideration is
complete. Document current
use of AT on the IEP.
No - Go to Part III.
Part III. Select one of the following and proceed as described.
AT is required. The IEP team knows the nature and extent of the AT devices/services needed and will address AT in the student’s IEP.
AT may be required. The IEP team determines that additional information is needed and will conduct additional AT *screening or refer for AT assessment by _________ (date).
Record this statement on the IEP.
Comments:
Form completed by:
*AT screening may include additional observations, informal assessment or trials of AT devices and strategies.
Adapted from Wisconsin Assistive Technology Initiative (WATI), Miami-Dade County Assistive Technology Procedures, Georgia Project for Assistive Technology, Oregon Technology Access Program and St. Charles Parish
Public Schools Consideration forms.
1
Assistive Technology Consideration Checklist (cont.)
Student Name: ___________________________________
School: ____________________________________
Page
of
Date: ____________________________________
Directions: Use this additional workspace to identify areas of concern for Part II A and B. Return to Part II C to complete the Assistive Technology Consideration Checklist.
Part II. List the area(s) identified in Part I. Specify the task(s) the
Identify the environment(s) where that
Briefly list or describe any special strategies,
accommodations or technology already being used.
student is unable to do.
⎯⎯⎯→
task takes place. ⎯⎯⎯→
Return to Part II C to complete the checklist.
Adapted from Wisconsin Assistive Technology Initiative (WATI), Miami-Dade County Assistive Technology Procedures, Georgia Project for Assistive Technology, Oregon Technology Access Program and St. Charles Parish
Public Schools Consideration forms.
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Figure 2
List of Possible Assistive Technology
Page 1 of 2
Note: This list is provided to assist in the consideration of assistive technology for the development, review or revision of a student’s educational program. It
provides some tools and strategies that teams may want to investigate as possible technology solutions. This is not a complete list of assistive technology
resources and strategies. The educational team should consider additional resources when making decisions for a student’s needs.
A. Motor Aspects of Writing
S
‰ Accessible Instructional
Materials (AIM)
‰ Pencil or pen with adaptive grip
‰ Adapted paper (e.g. raised lines,
highlighted lines, and so on)
‰ Slantboard
‰ Portable word processor
‰ Computer
‰ Other:
‰
‰
‰
‰
‰
‰
B. Computer Access
S
‰ Keyboard using accessibility
options
‰ Keyguard
‰ Arm support (e.g. ergonomic
support)
‰ Track ball, track pad, joystick
with onscreen keyboard
‰ Alternate keyboard
‰ Mouth stick or head pointer with
standard or alternate keyboard
‰ Switch with Morse code
‰ Switch with scanning
‰ Voice recognition software
‰ Word prediction software to
reduce keystrokes
‰ Head mouse or head
master/tracer with onscreen
keyboard
‰ Other:
C. Composing Written Material
‰ Accessible Instructional
Materials (AIM)
‰
‰
‰
‰
S
Word cards, word book, or word
wall
Pocket dictionary or thesaurus
Electronic or talking electronic
dictionary, thesaurus, or spell
checker
Word processor with spelling
and grammar checker
Talking word processor for
multi-sensory typing
Multimedia software for
expression of ideas
(assignments)
Concept mapping and outlining
software
Word processor with word
prediction to facilitate spelling
and sentence construction
Voice recognition software
Other:
D. Communication
S
‰ Communication board or book
with pictures, objects, letters, or
words
‰ Eye gaze board (Eye gaze
communication)
‰ Simple voice output device
‰ Voice output device with levels
‰ Voice output device with
dynamic display
‰ Voice output device with icon
sequencing
‰ Device with speech synthesis for
typing
E. Reading
S
‰ Accessible Instructional
Materials (AIM)
‰ Changes in text size, spacing,
color, or background color
‰ Use of pictures with text
‰ Book adapted for page turning
(e.g. page fluffers, 3-ring binder,
cardboard in page protector)
‰ Talking electronic dictionary to
pronounce challenging words
‰ Flatbed scanner with talking
word processor
‰ Electronic books
‰ Text to speech software for Web
and electronic text
‰ Concept mapping and outlining
software
‰ Other:
F. Learning and Studying
S
‰ Accessible Instructional
Materials (AIM)
‰ Print or picture schedule
‰ Low-tech aids to find and
organize materials (i.e., index
tabs, color coded folders, pocket
notebooks/binders
‰ Highlight text (e.g. markers,
highlight tape, ruler)
‰ Software for manipulation of
objects or concept development.
Adapted from Wisconsin Assistive Technology Initiative (WATI), Miami-Dade County Assistive Technology Procedures, Georgia Project for Assistive Technology, Oregon Technology Access Program and St. Charles Parish
Public Schools Consideration forms.
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TFigure 2
List of Possible Assistive Technology
Page 2 of 2
L
‰
‰
‰
Software for organization of
ideas and studying
Recorded material (books on
tape, taped lectures with number
coded index)
Other:
‰
‰
‰
‰
G. Math
S
‰ Accessible Instructional
Materials (AIM)
‰ Abacus or math line
‰ Calculator, with or without print
out
‰ Talking calculator
‰ Calculator with large keys or
large LCD print out
‰ On-screen calculator
‰ Software with templates for
math computation (consider
adapted input methods)
‰ Tactile or voice output
measuring devices (e.g. clock,
ruler)
‰ Electronic math/concept
manipulatives
‰ Other:
H. Recreation
S
‰ Adapted toys and games (e.g.
toy with adaptive handle)
‰ Use of battery interrupter and
switch to operate a toy
‰ Adaptive sporting equipment
(e.g. lighted or bell ball, Velcro
mitt)
‰ Universal cuff to hold crayons,
markers, or paint brush
‰ Modified utensils (e.g. rollers,
stampers, scissors)
‰
Ergonomic arm support arm for
drawing or painting
Drawing or graphic program on
computer
Recreational computer
games/electronic games
Music software on
computer/adapted tape recorder,
etc.
Other:
I. Activities of Daily Living S
‰ Adaptive eating devices (e.g.
foam handle on utensil)
‰ Adaptive drinking devices (e.g.
cup with cut out rim)
‰ Adaptive dressing equipment
(e.g. button hook, reader)
‰ Other:
J. Mobility
S
‰ Walker
‰ Grab rails
‰ Manual wheelchair
‰ Powered mobility toy
‰ Powered wheelchair with
joystick, head switch, or sip/puff
controls
‰ Other:
SK. Environmental Contral
‰ Light switch extension
‰ Use of electronic control unit and
switch to turn on electrical
appliances (e.g. radio, fan,
blender, and so on)
‰ Radio or ultrasound remote
controlled appliances
‰ Other:
L. Positioning and Seating S
‰ Nonslip surface on chair to
prevent slipping
‰ Bolster, rolled towel, or blocks
for feet
‰ Adapted or alternate chair, side
lyer, stander
‰ Custom fitted wheel chair or
insert
‰ Other:
M. Vision
S
‰ Accessible Instructional
Materials (AIM)
‰ Eye glasses
‰ Magnifier
‰ Large print books
‰ Screen magnifier (mounted over
screen)
‰ Screen color contrast
‰ Screen magnification software
‰ CCTV (closed circuit television)
‰ Screen reader
‰ Braille keyboard and note taker
‰ Braille translation software
‰ Other:
N. Hearing
S
‰ Hearing aid
‰ FM System
‰ Classroom amplification
‰ Captioning
‰ Signaling device (e.g. vibrating
pager)
‰ TDD/TTY for phone access
‰ Screen flash for alert signals on
computer
‰ Other:
Adapted from Wisconsin Assistive Technology Initiative (WATI), Miami-Dade County Assistive Technology Procedures, Georgia Project for Assistive Technology, Oregon Technology Access Program
and St. Charles Parish Public Schools Consideration forms.
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