Get the free Assistive Technology Referral Form Student Name: D - broward k12 fl

Assistive Technology Referral Form Student Name: D.O.B.: Grade Level: Diagnostic Information (e.g., CP, TBI, seizure disorder, etc.): ESE Eligibility: School: Phone: Submitted by: Title: Parent(s)/Guardian(s):

How to fill out assistive technology referral form

How to fill out an assistive technology referral form:

1. Begin by carefully reading the instructions on the form. This will provide you with important information on how to properly fill out the form and what information is required.
2. Start by filling out your personal details such as your name, contact information, and any identifying numbers or codes provided.
3. Provide information about the individual who needs assistive technology. This may include their name, age, diagnosis, and any specific needs or challenges they face.
4. Be sure to accurately describe the type of assistive technology required. Include specific details such as the name or model of the device, any specific features that are important, and any supporting claims or recommendations from healthcare professionals if available.
5. If there are any relevant medical or therapeutic professionals involved in the process, provide their contact information and any necessary documentation or assessment reports they have provided.
6. If applicable, include information about any existing assistive technology devices or equipment the individual currently uses or has used in the past. This can help provide a comprehensive understanding of the individual's needs and preferences.
7. Make sure to review the completed form for any errors or missing information before submitting it. Double-check that all required sections have been filled out and that the information provided is accurate and up-to-date.
8. Keep a copy of the completed form for your records.

Who needs an assistive technology referral form:

1. Individuals with disabilities or special needs who require assistive technology to enhance their independence, mobility, communication, or daily functioning.
2. Caregivers or family members seeking assistance and support for their loved ones who have disabilities or special needs.
3. Healthcare professionals, therapists, or educators who are involved in the assessment, planning, and provision of assistive technology services for individuals with disabilities or special needs.

For pdfFiller’s FAQs

What is assistive technology referral form?

Assistive technology referral form is a document used to request assistive technology services for individuals with disabilities.

Who is required to file assistive technology referral form?

Individuals with disabilities or their guardians are required to file assistive technology referral form.

How to fill out assistive technology referral form?

Assistive technology referral form can be filled out by providing the necessary information about the individual, their disability, and the requested assistive technology services.

What is the purpose of assistive technology referral form?

The purpose of assistive technology referral form is to ensure that individuals with disabilities receive the appropriate assistive technology services they need.

What information must be reported on assistive technology referral form?

Information such as personal details of the individual, nature of disability, requested assistive technology services, and contact information must be reported on the assistive technology referral form.

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