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AT Forms


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AT Forms

It is critical that a school district provide guidance to all staff in the delivery of assistive technology services. Part of that guidance should include forms that relate to the specific AT procedures described in a Policy and Procedures Manual. Classroom personnel see these forms as a continuation of AT policy; how AT is integrated into existing systems is well defined with the use of forms. If current forms and handbooks do not include AT information, then adapting existing forms or developing new forms will be a first step.

Suggested AT forms include:

  • Referral form to use when an IEP member or other individual, requests an AT assessment,
  • Form to guide and document the consideration of AT in the IEP meeting,
  • Form(s) to guide and document the assessment of a child's need for assistive technology,
  • Form to guide and document the decision-making process related to trial use of assistive technology
  • Form to describe the AT Implementation Plan
  • Areas on the IEP (or new forms/sections) where AT use should be documented
  • AT Loan Forms

Many districts have developed their own AT forms; others use and sometimes modify those developed by AT Groups listed below.

Wisconsin Assistive Technology Initiative
Permission is given by WATI to change the header on any of the forms to include your organization name. You only need to retain references to WATI at the bottom of each page.

  • Overall Process
    • Directions/Procedure Guide
  • Information Gathering
    • AT Consideration Guide
    • Referral/Question Identification Guide
    • Student Information Guide.
    • Environmental Observation Guide
  • Decision Making
    • AT Decision Making Guide
    • AT Checklist
  • Trial Use
    • AT Trial Use Guide
    • AT Trial Use Summary

Georgia Project for AT Resources
This AT site provides forms including AT consideration checklists, Student background information and various Assessment protocol forms.

  • Consideration Checklist & Assistive Technology Resource Guide
  • Background information protocol
  • Augmentative Communication Protocol
  • Academic and Learning Aids Reading Protocol
  • Academic and Learning Aids Written Expression Protocol
  • Academic and Learning Aids Additional Academic Information Protocol
  • Computer Access Protocol
  • Vision Protocol
  • Voice Recognition Protocol

EXTRA!!! You can view short video clips of AT listed in the GPAT Resource Guide at the Georgia's Valdosta State University website. This is an excellent source increasing awareness when considering AT.

Boston Public Schools Access Technology Center
This site provides tools to support the use of AT in public schools to identify student areas of need and to provide appropriate no/low, mid and high tech support strategies and tools for diverse learners. Forms include specific curricular examples of tools related to Student Access Map (SAM) materials:

  • SAM Flow Chart
  • Sam Access Maps for Reading and Writing
  • Tools & Strategies to support access to standards-based learning



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