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INITIAL REFERRAL FORM ORIENTATION AND MOBILITY NAME: Appalachia Intermediate Unit 8 Dr. Thomas Butler Executive Director BIRTH DATE: SCHOOL: GRADE: SCHOOL DISTRICT OF RESIDENCE: PARENT(S) NAME: ADDRESS:
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Gather necessary information: Before filling out the orientation and mobility forms, make sure to gather all the required information such as personal details, contact information, medical history, and any specific needs or accommodations.
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Follow the instructions: Read the orientation and mobility forms carefully and follow the provided instructions. Pay attention to any specific guidelines or sections that require additional documentation or signatures.
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Provide accurate information: Fill out the forms truthfully and accurately. Double-check your responses to ensure they are correct. It is essential to provide information that reflects your current situation and needs.
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Seek assistance if needed: If you encounter any difficulties or have questions while filling out the forms, do not hesitate to seek assistance. You can reach out to the organization or institution providing the orientation and mobility services for guidance or clarification.
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Submit the completed forms: Once you have filled out the orientation and mobility forms, review them one last time for accuracy and completeness. Make sure all required sections and fields are filled. Sign and date the forms if necessary. Finally, submit the forms to the appropriate recipient as instructed.

Who Needs Orientation and Mobility:

01
Individuals with visual impairments: Orientation and mobility services are primarily designed for individuals who have visual impairments or blindness. This can include people of all ages, from young children to older adults.
02
People with limited mobility: Orientation and mobility services can also be beneficial for individuals with mobility impairments, such as those who use wheelchairs or walkers. These services can help them navigate their surroundings, access transportation, and learn techniques to enhance their mobility.
03
Persons with acquired brain injuries or cognitive impairments: Orientation and mobility services may be necessary for individuals who have acquired brain injuries or cognitive impairments that affect their spatial awareness, decision-making abilities, or orientation skills.
04
Individuals transitioning from institutional to community living: Orientation and mobility services can support individuals who are transitioning from institutional settings, such as hospitals or rehabilitation centers, to community living. They help these individuals become familiar with their new environments, navigate public spaces, and gain independence.
05
People with age-related vision changes: As people age, they may experience vision changes or conditions like macular degeneration, glaucoma, or cataracts. Orientation and mobility services can assist them in adjusting to these changes, learning new techniques, and maintaining their independence.
Remember, it is important to consult with professionals or organizations specializing in orientation and mobility to determine the specific needs and eligibility for these services.
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Orientation and mobility refers to the ability of individuals to navigate and move around their environment safely and independently, especially for those with visual impairments or mobility challenges.
Orientation and mobility services are typically provided by professionals such as orientation and mobility specialists, teachers of the visually impaired, or physical therapists.
Filling out orientation and mobility services involves assessing an individual's current skills, setting goals for improvement, and implementing a plan to enhance their ability to navigate and move around effectively.
The purpose of orientation and mobility services is to empower individuals with visual impairments or mobility challenges to gain independence, confidence, and safety in their daily living activities.
Information reported on orientation and mobility may include the individual's current mobility skills, challenges faced in navigating their environment, progress made in the training, and any recommendations for future improvement.
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