Ann Arbor Public Schools
STUDENT INTERVENTION & SUPPORT SERVICES
2555 South State Street
Ann Arbor, Michigan 48104-6145
Telephone & TDD (734) 994-2318
Voice Mail Boxes 994-8292, Fax 994-1826
Assistive Technology Decision-Making Process
Part 1: Beginning the Process
Student Name
Student ID
Date of AT Meeting
Address
City
State
ZIP
Telephone
Attending Building
Eligibility
Birth Date
Person Making Referral
MI
Team Members: Please identify all team members involved with this student.
Check those Present for AT meeting.
Case Manager
Parent/Guardian
Teacher Consultant
Teacher Assistant
OT
PT
SLP
Psychologist
Social worker
Administrator
AT Consultant
Others
Relevant Medical/Physical/Behavioral Considerations:
Eligibility:
Referral Question: What task(s) does the student need to do that is currently difficult or impossible,
and for which assistive technology may be an option?
Social and functional communication in class and community to communicate basic wants and needs
Based on the referral question, select areas of concern and check all areas that apply.
Motor Aspects of Writing
Fine Motor Related to Keyboarding, Computer, or Device Access
Composing Written Material
Communicating
Reading
Learning, Studying, or Organizing
Math
Adapted from WATI Assessment Package (2004) and SETT, Joy Zabala, (1994)
Recreation and Leisure
Seating and Positioning
Mobility
Vision
Hearing
Environmental
Other
Part 2: Problem Identification and Intervention Planning
Tasks
Environment
Student
What is the student’s
present level of
functioning
regarding this task?
What specific parts
of this task are
difficult for the
student?
Conditions within
customary
environments
List both barriers
and supports
What are the taskspecific outcomes for
the student and what
data is needed to
demonstrate
achievement? Star
(*) according to
priority.
Tools
What has already
been tried? What
was the outcome?
Brainstorm possible
solutions for the
priority outcomes.
Star(*) solutions to
be tried first.
Notes:
Adapted from WATI Assessment Package (2004) and SETT, Joy Zabala, (1994)
Part 3: Trial and Follow-Up Plan
Student Name:
Date:
Tasks
What at
will be
tried?
How will the AT be
integrated into
instruction?
How
How will the team:
*Acquire the AT
*Provide training
Collect
data
Define trail
assignments/ use.
Determine data to be
collected.
Who
Who will :
*Acquire the AT
*Provide training
*Collect data
Dates for:
*Trial periods
*Follow-up meetings
Follow-up
Task-specific
Outcome(s)
Addressed
When
Referral Question: What task(s) does the student need to do that is currently difficult or impossible, and for which assistive
technology may be an option?
Expected Outcome
*Criteria Met?
(Show supporting
data.)
Next Steps
e.g. Recommendation
for IEP, Other AT
to be tried,
Comments
Notes:
Adapted from WATI Assessment Package (2004) and SETT, Joy Zabala, (1994)