Assistive Technology Screening
Student:
Parent:
School:
Grade:
School Year:
Teacher:
ESE:
Date:
Person(s) completing screening:
Do you believe the student requires an assistive device to access educational programming?
Yes
No
Does the student believe there is a need to be addressed?
Yes
No
Identify the areas of the curriculum for which technology is required:
What specific skill will the student be able to access if the school staff implements the use of assistive
technology?
What technology interventions have (a) been tried in the past? (b) been successful? Explain:
Was the student motivated to use or interested in the interventions tried?
Is further evaluation needed to determine if assistive technology would be effective?
Yes
No Explain:
How would assistive technology help the student perform efficiently in the least restrictive environment?
Assistive technology is valuable to a student only if it is used. The school staff is responsible for the
implementation and use of trial devices as well as any designated technology selected for the student.
10/01/06