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Assistive Technology Consideration Form
Student Sample: Communication/seating/recreation
Student Name
(elementary age)
DOB
Case Manager
Person Completing Form
Date Completed
Purpose of this form:
1. To consider Assistive Technology needs; To determine Instructional Areas and Tasks that are difficulty for the student; To determine whether the student can accomplish
the difficult tasks with standard classroom tools and/or accommodations or if assistive technology is needed.
Section 1. Check () the instructional area below that the student exhibits difficulty?
Math
Reading
Listening
x
Oral communication
Assessments/tests
Worksheets
Note-taking/copying work
Computers
Handwriting
Reports
x
Seating/positioning/mobility
x
Recreation/leisure
Writing
Study/organizational
Groups/group work
Projects
Presentations
Prevocational/vocational
Spelling
Attention/behavioral
Centers
Physical classroom
Daily living
Instructional methodsdiscussion/questioning
Section 2. Write in Column A the instructional areas and tasks that are difficult for the student.
Write in Columns B, C, and D the tools, accommodations, and/or assistive technology necessary for the student to complete the tasks identified in Column A.
Use the AT Considerations Resource Guide to help in completing this section.
Column A
Column B
Instructional Area and Tasks
Standard Classroom
Tools
(areas of difficulty from section 1 above - math,
reading, etc and the tasks related to that area
such as copying from board, writing name, etc)
Oral Communication
 Gain attention of peers/adults
 Provide appropriate greetings and
farewells
 Express continuance or make
choices during activities
Seating, Positioning, and Mobility
 Move about/ambulate about the
classroom, school, and/or community’
 Maintain appropriate
seating/positioning


Interactions with
others (teachers,
peers)
Classroom desks,
chairs, and tables






Column C
Completes tasks with Accommodations and/or Assistive
Technology currently in place or readily available
Possible Accommodations
Assistive Technology
currently in place or
available
Verbal prompts and reminders
of appropriate responses
Modeling appropriate skills
Additional response time
Provide questions ahead of time
Adult and peer assistance
Limit mobility requirements by
carefully scheduling of
classes/activities


Column D
Possible Assistive Technology
**items not readily available and trial
use is necessary


Trial use of:
Augmentative communication
devices (picture boards, talking
switches, voice outputs)
Speech enhancing devices
Adapted chairs
Adapted tables and
desks
Coweta County Special Education Department
Revised: February 2010
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Recreation and Leisure
 Appropriately manipulate and operate
toys, tools, electronic devices for
leisure activities

Puzzles, games,
toys, music




Verbal prompts
Adult/peer assistance
Modeling appropriate skills
Hand over hand assistance
Section 3. Consideration Outcomes:
Circle the correct answer and follow the appropriate instructions.
1.
Can the student independently accomplish the tasks using standard classroom tools? Yes or No?
a. If yes, AT is not required and the decision-making ends here
b. If no, continue to question 2
2.
Can the student accomplish the tasks with classroom accommodations? Yes or No?
a. If yes, AT is not required and document in the IEP the necessary classroom accommodations written above or any other accommodations recommended by the
IEP team and decision-making ends here
b. If no, continue to question 3
3.
Can the student accomplish the tasks with assistive technology that is currently in place or readily available in your school? Yes or No
i. “Currently in place” means that the student currently uses the item and it is in his/her IEP.
ii. “Readily available” means that you have or can provide or purchase the AT item within your school
b. If yes, document in the IEP the assistive technology devices and services indicated above and decision making ends here.
i. Document AT in the supplementary aids and services section of the IEP
ii. Provide the required AT tools per the IEP to the student
c. If no, continue to question 4
4.
Does the student require assistive technology that is not readily available in your school? Yes or No
a. If yes, document in the IEP that AT referral is needed. (do not write specific AT items in the IEP at this time – student must go through trial basis)
i. Contact AT Representative in your school or AT Representatives at Central Office to determine if the item is already available within the county and
can be sent for the student to use on a trial basis. Data should be collected during the trial use of the AT item.
ii. A complete AT Referral Packet is only necessary if the IEP Team does not know what would be appropriate AT items for the student. County AT
Representatives will let the case manager know if a complete AT Referral Packet is necessary.
b. If no, AT is not required and question 1, 2, and/or 3 above should have been answered yes.
**Student currently uses adapted chairs, tables, and desks – indicate in the IEP; however, team would like trial basis of AT device for communication.
Specify any assistive technology services required by the student:
Staff should be trained in the use of the adapted seating.
Coweta County Special Education Department
Revised: February 2010
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Coweta County Special Education Department
Revised: February 2010