Assessing Student's Needs for Assistive Technology (ASNAT)

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Assistive Technology Assessment Forms Referral/Question Identification Guide Student’s Name Date of Birth Age School Grade School Contact Person Persons Completing Guide Date Phone Parent(s) Name Address Phone Student’s Primary Language Family’s Primary Language Disability (Check all that apply.) Speech/Language Significant Developmental Delay Specific Learning Disability Cognitive Disability Other Health Impairment Hearing Impairment Traumatic Brain Injury Autism Vision Impairment Emotional/Behavioral Disability Orthopedic Impairment – Type Current Age Group Birth to Three Early Childhood Elementary Middle School Secondary Classroom Setting Regular Education Classroom Resource Room Self-contained Home Other Current Service Providers Occupational Therapy Other(s) Physical Therapy Speech Language Medical Considerations (Check all that apply.) History of seizures Fatigues easily Has degenerative medical condition Has frequent pain Has multiple health problems Has frequent upper respiratory infections Has frequent ear infections Has digestive problems Has allergies to Currently taking medication for Other – Describe briefly Other Issues of Concern Assessing Students’ Needs for Assistive Technology (2004) A-5
Assistive Technology Assessment Forms Assistive Technology Currently Used (Check all that apply.) None Low Tech Writing Aids Manual Communication Board Augmentative Communication System Low Tech Vision Aids Amplification System Environmental Control Unit/EADL Manual Wheelchair Power Wheelchair Computer – Type (platform)_____________ Voice Recognition Word Prediction Adaptive Input - Describe Adaptive Output - Describe Other Assistive Technology Tried Please describe any other assistive technology previously tried, length of trial, and outcome (how did it work or why didn’t it work.) Assistive Technology Number and Dates of Trial(s) Outcome Assistive Technology Number and Dates of Trial(s) Outcome Assistive Technology Number and Dates of Trial(s) Outcome REFERRAL QUESTION What task(s) does the student need to do that is currently difficult or impossible, and for which assistive technology may be an option? Based on the referral question, select the sections of the Student Information Guide to be completed. (Check all that apply.) Section 1 Fine Motor Related to Computer or Device Access Section 2 Motor Aspects of Writing Section 8 Recreation and Leisure Section 9 Seating and Positioning Section 3 Composing Written Material Section 10 Mobility Section 4 Communication Section 11 Vision Section 5 Reading Section 12 Hearing Section 6 Learning and Studying Section 13 General Section 7 Math Assessing Students’ Needs for Assistive Technology (2004) A-6
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Assessing Students’ Needs for Ass
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Table of Contents Chapter One Assis
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Table of Contents Chapter 8 Assisti
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Chapter 1 - Assistive Technology As
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Notes: Chapter 1 - Assistive Techno
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Chapter 2 - Computer Access A CONTI
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Chapter 2 - Computer Access • Wor
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Chapter 2 - Computer Access • Mou
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Chapter 2 - Computer Access ♦ The
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Chapter 2 - Computer Access Freewar
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Chapter 2 - Computer Access Notes:
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Chapter 3 - Assistive Technology fo
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Chapter 9 - Documenting Assistive T
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Chapter 10 - Funding Assistive Tech
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Page 294 and 295: WATI Product Catalog WATI PRODUCT C
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Page 298 and 299: WATI Product Catalog School Profile
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Assessing Student's Needs for Assistive Technology (ASNAT)

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