Get the free Assistive Technology Referral Form - IPOWER

Assistive Technology Referral Form Student Name School: Date of Birth: Age: Sex: Grade: Parent×Guardian: Home Phone Address: Work Phone Email Address: Exceptionally: Related Services: Teacher: Paraprofessional:

How to fill out assistive technology referral form

How to fill out assistive technology referral form?

1. Start by carefully reading the instructions provided on the assistive technology referral form. It is important to understand the purpose and requirements of the form.
2. Begin by providing your personal information such as your name, contact details, and any other required identification information. This will help the authorities process your referral accurately.
3. Next, you may be required to provide information about the individual who needs assistive technology. Include their name, age, gender, and any relevant medical or disability-related information. Make sure to provide as much detail as possible to ensure the proper assessment and allocation of appropriate assistive technology.
4. The form may also ask for information about the individual's current functional abilities and limitations. This can include their mobility, communication skills, hearing or vision impairments, and any other relevant information. Be honest and provide as accurate information as possible to aid in the selection process.
5. In some cases, the referral form may require you to provide a detailed explanation of why assistive technology is needed and how it can benefit the individual. Specify the challenges they face without assistive technology and explain how the recommended technology can enhance their independence and quality of life.
6. Additionally, you may need to include any supporting documentation or assessments that can help validate the need for assistive technology. This can include medical reports, evaluations from healthcare professionals, therapy assessments, or any other relevant documents.

Who needs assistive technology referral form?

1. Individuals with disabilities: The assistive technology referral form is primarily designed for individuals with disabilities who require additional support or assistance to enhance their functional abilities. This can include individuals with physical impairments, sensory impairments, cognitive impairments, communication difficulties, or any other disabilities that can potentially be aided by assistive technology.
2. Healthcare professionals: Healthcare professionals, therapists, or practitioners who work closely with individuals with disabilities may also use assistive technology referral forms. They can use these forms to recommend assistive technology devices or services that can benefit their patients and improve their overall well-being and independence.
3. Educational institutions: Schools, colleges, or universities that have students with disabilities may require the completion of assistive technology referral forms. These forms can help identify the specific needs of students and ensure that the appropriate assistive technology is provided to support their education, participation, and inclusion within the educational setting.

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What is assistive technology referral form?

Assistive technology referral form is a document used to refer individuals in need of assistive technology devices or services to the appropriate resources or agencies.

Who is required to file assistive technology referral form?

Healthcare professionals, educators, therapists, or any individual who identifies a need for assistive technology may be required to file the form.

How to fill out assistive technology referral form?

The form should be completed with the individual's personal information, details of their disability or need, and the recommended assistive technology devices or services.

What is the purpose of assistive technology referral form?

The purpose of the form is to ensure individuals with disabilities receive appropriate assistive technology devices or services to improve their quality of life.

What information must be reported on assistive technology referral form?

Information such as the individual's name, contact details, disability or need, recommended devices or services, and any relevant medical or educational history should be reported.