Asistencia Tecnológica
para Maestros

Lo sentimos mucho pero la Forma de Asistencia Tecnológica para Maestros está solamente disponible en Ingles.

¡HAGA CLIC AQUÍ para la versión de la impresora de esta forma!

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Form completed by:	Date (mm/dd/yy):
Title:	Agency:
Address:
City:	State: Zip:
Telephone:	Email:

Please check the area(s) in which you would like assistance and specify the assistance needed:

Identification of students who are deafblind (e.g., review of records, at-risk factors).
Specify:
Specify request here.
Inclusion/Integration (e.g., strategies for including students with dual sensory impairments in the regular classroom, child care settings, natural environments; adapting activities; achieving IEP objectives or IFSP outcomes).
Specify:
Specify identification request here.
Functional Assessment (e.g., evaluating the individual within daily environments to determine functional needs, significant other interviews, writing functional IEP goals and objectives or IFSP outcomes).
Specify:
Specify functional assessment request here.
Functional Curriculum (e.g., emphasizing meaningful skills and activities for maximizing independence now and in the future; emphasizing age-appropriate skills; teaching skills within natural routines and activities; activity-based instruction).
Specify:
Specify functional curriculum request here.
Systematic and Data-based Instruction (e.g., individualizing instructional plans, documenting progress, modifying plans based on student performance).
Specify:
Specify systematic and data-based instruction request here.
Communication (e.g., nonsymbolic communication strategies, augmentative/ alternative communication, object/picture schedules).
Specify:
Specify communication request here.
Community-based Instruction (e.g., establishing community-based instruction, teaching in the community, instruction in natural environments).
Specify:
Specify community-based instruction request here.
Positive Behaivor Support (e.g., positive procedures, nonaversive strategies, teaching alternative skills, documenting change, assessment for intervention planning, purpose of problem behavior).
Specify:
Specify positive behavior support request here.
Transition Planning (e.g., assessing for transition; writing transition plans; educational transitions such as early intervention to preschool, elementary school to middle school).
Specify:
Specify transition request here.
Vocational Services (e.g., identifying activities, adaptations, labor laws).
Specify:
Specify vocational service request here.
Collaborative Teaming (e.g., identifying team members, role release among professionals from varying disciplines, collaborative assessment, writing collaborative IEP goals and objectives or IFSP outcomes, ongoing monitoring, activity-based therapy).
Specify:
Specify collaborative teaming request here.
Functional Vision/Hearing Assessments (e.g., meaningful recommendations, reading audiograms, conducting functional vision assessments).
Specify:
Specify functional vision/hearing assessment request here.

Type of Assistance Desired:
Consultant to my classroom to help with a specific child
In home consultation to help with a specific child/student
Inservice Workshop
Written materials, if available
Video materials if available
Please call me