Please return to:
District Technology Coordinator
@ local Ministry of Education office
Assistive Technology
Transfer Form
01
Assistive Technology Details
Current school to complete (school from which student is transferring)
Student name:
Current school:
Date of birth:
New school:
or leaving school
or no longer requires this assistive technology
If the assistive technology is no longer required or the student is leaving school please contact the district technology
coordinator at your local Ministry of Education office.
List of assistive technology provided by the Ministry of Education
(You can request a list of current allocated equipment from your local Assistive Technology Coordinator).
Ministry of Education equipment ID
number (if known)
Other Equipment: for example Ministry of Health, ACC or other funded technologies such as a hoist, standing frame, slope
board, communication devices etc (include serial numbers and source of technology if known):
Other equipment
02
Serial numbers as appropriate
Transfer Checklist
Current school to complete (school from which student is transferring)
To help with the transition for the student, please complete all sections that apply to this technology for the new school
support team.
Transfer arrangements: Please outline the transfer arrangements if applicable (such as courier details, storage etc):
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ASSISTIVE TECHNOLOGY – Supporting Students with Special Needs
Yes
N/A
This assistive technology is safe, and is in good working order
This assistive technology is being transferred with all documentation eg software information, manuals
If the device is being returned, all personal data (files and photos etc) have been removed from the device
The school have removed all administrative passwords, network/domain settings, and device from asset register
A copy of purchase invoice and supplier details has been given to the new school
A copy of most recent application for this technology has been given to the new school
Device Settings (if applicable):
Serial numbers:
Account name and address used:
Passwords used:
Security questions & answers used:
Other useful details:
How was this device used?
An example of HOW this technology was used by the student has been provided to the new school
This could be in the form of
written instruction sheet
video
photographs
visual story
face-to-face training
Other useful details:
Ongoing support:
Contact for repairs/maintenance:
Contact for supplier:
Other useful contacts:
Person completing this form (section 1 & 2):
Name:
Role:
Signed:
Date:
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ASSISTIVE TECHNOLOGY – Supporting Students with Special Needs
03
Management Plan - New school to complete
New school – to outline how the assistive technology will be cared for:
Ongoing maintenance:
School IT support
Supplier Support
Not Applicable
Stored on teachers desk
Not Applicable
Goes home during holidays
Not Applicable
Other (please specify):
Portable devices:
Stored in locked cupboard
Other (please specify):
Homework:
Goes home regularly
Does not go home unless given special permission
Other management:
04
New school responsibilities
Agree
This assistive technology has been received with all documentation (copy of purchase records, software information,
manuals etc), and is in good working order.
Bring your own device policy:
I understand that if the student is entering into a digital class or a BYOD class where all students are required to have a
device, the student is able to continue to use the allocated device(s). If the device requires upgrading to meet the class
requirements, or any repairs or maintenance, they would not be eligible for additional Ministry of Education funding. The
responsibility for this will be as per the schools policy on BYOD devices. Ministry of Education support continues to be
available if the student requires any specialized assistive technology in addition to the required class device.
Agree
Please note the following processes and conditions must be followed. You accept that the school:
1. Will assume ownership of the assistive technology for the time that the student is enrolled in the school, including
listing the technology on the school’s asset register, and maintaining a record of the serial numbers, asset numbers
and warranty conditions.
2. Will ensure that the assistive technology is used for the intended purpose by the student it is allocated for.
3. Is responsible for the safekeeping of all assistive technology items such as original software, manuals and accessories
etc. as documented in the management plan.
4. Is responsible for insuring the assistive technology and will contact the local Ministry of Education office if repair,
maintenance or replacement of the item is needed (for more information on the Ministry of Education and school
responsibilities in case of loss, damage or replacement, please see the Insurance and Repairs Fact Sheet).
5. Will support the implementation and ongoing use of the assistive technology within the school including the agreed
training plan if applicable.
6. Will load appropriate school software and use appropriate school technology to support the student such as generic
programs like Microsoft Office, virus software and access to school networks.
7. Will notify the local Ministry of Education office when the named student transfers to another institution or leaves
school, and will transfer the assistive technology to the new school (with the student) or return it to the Ministry of
Education.
8. Agrees that the scanned version of this document can act as the record copy for this transfer.
Principal name:
Signed (Principal):
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School:
Date:
ASSISTIVE TECHNOLOGY – Supporting Students with Special Needs