Assistive Technology Pre-referral Checklist Example by stariya


									                                                                                    _______County Schools
                                                                                  Exceptional Children’s Program
                                                               ASSISTIVE TECHNOLOGY PRE-REFERRAL CHECKLIST

 Date:_____________________Student’s Name:______________________________________________
 Instructions: Circle the items tried with the student prior to making an AT referral. Items tried with the student should follow the progression
 down the form in the relevant column. An AT Referral should be made only after several items in the column have been tried from each
 level. Add additional comments on the back of the form.
                              HANDWRITING                    READING                  ARITHMETIC                                       DAILY ORGANIZATION
                                                                                                               EXPRESSION                                            Communication
                         Tracing exercises             Use story frame             Use number lines        Content outlines           Color coding strategies      Picture schedules
                         “Talk through” letter         Use before, during,         Use mnemonic            “Webbing” strategies       Homework journal             Adapted stories
                         formation                     after echo reading          devices                 Writing / story starters   Pocket schedule              Books on Tape
                         Dot-to-dot                    Story mapping               Use “two finger”        Formulate sentences        Notebook schedule            Song Boards
                         Multi-modality instruction    Multi-modality              counting aids           aloud                      Schedule on desk

                         Chalkboard practice           teaching                    Using color coding      Peer tutor                 Schedule on bulletin board

                                                       Structured study            strategies                                         Peer Support
                                                       guides                      Use multi-modality
                                                       Peer tutor                  approach use
                                                                                   computational aids
                                                                                   Peer tutor

                         Adapt test to fill-in-the-    Highlight key               Reduce the number       Allow extra time           Assignment sheets            Choice-making using
                         blank, multiple choice, or    concepts                    of problems             Shorten assignment         Appointment book             objects/pictures/words
                         true-false                    Extra time for              Eliminate the need to   Provide key words          Reminder cards               Varying choice-
                         Provide additional time       completion                  copy problems            Study carrel              Structured study guides      making options
                         Shorten assignments           Shorten assignments         Enlarge worksheets      Fill in the blank          Post signs and label areas   Pens
                         Photo copied notes            Simplify text               Avoid mixing “signs”    classroom notes            in room                      Gestures
    Task Modifications

                         Peer notes on NCR Paper       Use chapter outlines        on a page                                          Try study carrel             Pointing
                         Try different writing tools    Information                Reduce number of                                    Organize desk               Speech/Vocalizations
                         Check paper position          organizer                   problems on page                                                                Sign language
                         Check student position:        Study carrel               Allow more time                                                                 Finger spelling
                           Feet/pelvis/trunk and       Provide tactile letters,    Try graph paper                                                                 Facial expressions
                         arm/hand                      words
                         Use Sharpened Pencil
                         Use Short Pencil
                         Try alternative Paper

                         Pencil holders/grips          Page magnifiers             Abacus                  Word cards                 Pocket organizer/planner     Pointing device
                         Large/primary pencils         Magnifying bars             Counters-spools,        Sentence cards             Personal organizer           Picture symbols
                         Large crayons/markers         Colored                     buttons, etc.           Pocket dictionary          Clipboard                    Letter/picture board
                         Different kind/color paper    Transparencies              Containers for          Pocket thesaurus           Sticky notes                 Communication board
                         Different line                Word                        counters                Personal “word” book       Notebook tabs                Communication book

                         spacing/color                 window/Masking              Manipulatives                                      Post-it tape flags           Eye gaze frame
                         with markers                  Flash cards                 Flash cards                                        Colored paper clips          Single message
                         Colored Transparencies        Letters and word            Automatic number                                   Highlighter                  device e.g. BigMack
                         Light pen                     cards                       stamp                                              Storage cubicles             Singe message
                         Tape paper to the desk        Sentence cards              Magnetic numbers                                   Timer                        device with levels
                         Dycem to hold paper           Highlighter                 on metal tray                                                                   e.g. Step-by-Step
                         Clipboard to hold paper       Post-it tape flags          Personal
                         Stencils/templates            Colored keyed               chalkboard/dry erase
                         Rubber name stamp             paperclips to mark          board
                         Other rubber stamps           Pages/paragraphs            Raised or enlarged
                         Magnetic board/letters        Highlighter Tape            number line
                         Slant board/easel                                         Number fact charts
                         Wrist rest/support                                        Multiplication Grid
                         Arm stabilizer/arm guide

                         Access to school              Books on tape               Hand held calculator    Access to school                                        4-6 cell voice-output

                         computer                      Use voice output and                                computer with spelling                                  device
                         Portable word processor       talking word                                        and grammar                                             32 Message

                         that interfaces with          processing software                                 Checker, macros,                                        Communicator
                         computer                                                                          word prediction                                         Tech Speak
                         Use macros                                                                        software                                                Dedicated voice
                         Use spell checker                                                                 Graphic organizer                                       output device
                         Use word prediction                                                               software                                                e.g. Dynavox or Echo
                         software                                                                                                                                  Computer with voice

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