Assistive Technology Consent Form
Butler County Special Education COOP
Assistive Technology Support Team
The BCSE Assistive Technology Support Team provides services in assistive technology for all
special education students, special education staff, and parents of children in special education
throughout Butler County. The team is a transdisciplinary team whose members integrate their
areas of expertise to assess the unique abilities and needs of the student. Depending on the
student’s needs, the team may include: an occupational or physical therapist, a speech/language
pathologist, a vision or hearing specialist, a technology specialist, and other educators. As
appropriate, work with the building staff and the family of the student to explore and implement
technology solutions to meet the needs of students with disabilities.
Through the assessment process, one or more of the following may occur:
1. Determining the need for assistive technology.
2. Sharing of information regarding technology resources.
3. Assisting in the process of obtaining appropriate technology to try out.
4. Training in the use of hardware or software.
5. Facilitating the collection of data on trial use of equipment or software.
-------------------------------------------------------------------------------------------------------------------------------CONSENT FORM FOR AN ASSISTIVE TECHNOLOGY ASSESSMENT
I hereby give consent for the BCSE Assistive Technology Support team to evaluate:
____________________________________.
Student Name
_______________________________________
Parent or Guardian signature
____________________
Date
I hereby give consent for the BCSE Assistive Technology Support Team to video and/or take
pictures of my child using various pieces of assistive technology for documentation of progress,
presentation and student files.
_______________________________________
Parent or Guardian signature
____________________
Date