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SP0028 5/09 ASSISTIVE TECHNOLOGY REFERRAL FORM Department of Special Education Lincoln Public Schools School Year: Student s Name: ID #: Date: Current School: Current Grade: Future School: Verification:

How to fill out assistive technology referral form

How to Fill Out Assistive Technology Referral Form:

1. Start by gathering all the necessary information. This includes the individual's basic personal details such as name, address, and contact information.
2. Next, identify the reason for the referral. Provide a concise description of the individual's disability or condition that necessitates the use of assistive technology. Be clear and specific in explaining the challenges they face and how assistive technology can help them.
3. Specify the type of assistive technology needed. There are various forms of assistive technology available, such as mobility aids, communication devices, vision or hearing aids, and specialized software or equipment. Indicate the specific device or technology that is being requested or recommended.
4. Include any relevant medical or educational documents. Attach any supporting documentation, such as medical reports, educational assessments, or diagnostic evaluations that provide a comprehensive understanding of the individual's needs and their suitability for assistive technology.
5. Provide information about the referring professional. This typically includes the name, title, contact details, and affiliation of the person or organization who is making the referral. It's important to establish credibility and provide any necessary contact information for follow-up or clarification.

Who Needs Assistive Technology Referral Form:

1. Individuals with disabilities or special needs who require support in overcoming barriers or limitations can benefit from an assistive technology referral form. This includes people with physical, sensory, cognitive, or communication impairments.
2. Students in educational settings who require accommodations to fully participate in classroom activities may need an assistive technology referral form. This helps educational professionals assess the specific requirements and provide appropriate resources or support services.
3. Health professionals, such as doctors, therapists, or rehabilitation specialists, who identify the need for assistive technology as part of their patient's overall treatment plan, may utilize a referral form to facilitate the process.

In summary, filling out an assistive technology referral form involves collecting pertinent information, describing the need for assistive technology, specifying the required technology, providing supporting documents, and including contact details for the referring professional. This form is essential for individuals with disabilities or special needs, especially students and those working with healthcare professionals, who require help in overcoming their challenges and improving their quality of life.

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What is assistive technology referral form?

Assistive technology referral form is a document used to request specialized technology or equipment that can aid individuals with disabilities in their daily activities.

Who is required to file assistive technology referral form?

Individuals with disabilities, their caregivers, or healthcare professionals may be required to file an assistive technology referral form.

How to fill out assistive technology referral form?

Assistive technology referral forms can generally be filled out online or in person, providing necessary information about the individual's disability and the type of technology or equipment needed.

What is the purpose of assistive technology referral form?

The purpose of an assistive technology referral form is to assess the needs of individuals with disabilities and provide them with appropriate technology or equipment to improve their quality of life.

What information must be reported on assistive technology referral form?

Information such as the individual's medical history, type of disability, specific needs for technology or equipment, and contact information is typically reported on an assistive technology referral form.

Where do I find assistive technology referral form?

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