Assistive Technology Considerations Checklist

Source: Reprinted with permission from the Georgia Project for Assistive Technology, Georgia Department of Education, Atlanta.

Note: From Assistive Technology for Students Who Are Blind or Visually Impaired: A Guide to Assessment, by Ike Presley and Frances Mary D'Andrea, copyright © 2009, AFB Press, New York. All rights reserved. This form may be copied for educational use only.

Description: This is a blank Assistive Technology Considerations Checklist form. Blank areas following colons indicate blank fields. Those marked with "__" indicate checkboxes unless preceded by "(fill in the blank)" to indicate a blank text or number field.

Student:

School:

Directions

1. Complete the student information section below to provide information on the student's needs, abilities, and difficulties as well as environments and barriers to success.

2. Please check the instructional or access areas in Column A that are appropriate for the student. Please leave blank any areas that are not relevant to the student. Specify all relevant tasks (for example, copying notes from board, responding to teacher questions, and so on) within each area in the space provided. Check the settings in which the task is required. GEC: General Education Classroom; SEC: Special Education Classroom; COM: Community; and HOM: Home.

3. In Column B, specify the standard classroom tools (low technology to high technology) used by the student to complete relevant tasks identified in Column A. Place a check in Column B if the student is able to independently complete the tasks with standard classroom tools. For areas in which the student can complete the tasks independently, it will not be necessary to complete Columns C or D.

4. In Column C, specify the accommodations/modifications and assistive technology solutions that are currently being utilized. Place a check in the boxes in Column C if the student can adequately complete the tasks specified in Column A using the identified accommodations/ modifications and assistive technology solutions.

5. Complete Column D if the student cannot adequately complete the task with accommodations/ modifications and assistive technology solutions specified in Column C.

Student needs, abilities, and difficulties:

Student environments:

___ General Education Classroom (List all classes):

___ Special Education Classroom (List all classes):

___ Community (List all settings):

___ Home:

Barriers to student performance and achievement:

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A table follows.

Description: This table has four column heads: A. Instructional or Access Areas

B. Independent with Standard Classroom Tools; C. Completes Tasks with Accommodations/Modifications and/or Assistive Technology Solutions Currently in Place with subheads Accommodations/Modifications and Assistive Technology Solutions; D. Additional Solutions/Services Needed, Including Assistive Technology. Blank areas following colons indicate blank fields and those marked with "__" indicate checkboxes.

A. Instructional or Access Areas

___ Writing:

___ GEC

___ COM

___ SEC

___ HOM

B. Independent with Standard Classroom Tools:

C. Completes Tasks with Accommodations/Modifications and/or Assistive Technology Solutions Currently in Place

Accommodations/Modifications:

Assistive Technology Solutions:

D. Additional Solutions/Services Needed, Including Assistive Technology:

A. Instructional or Access Areas

___ Spelling:

___ GEC

___ COM

___ SEC

___HOM

B. Independent with Standard Classroom Tools:

C. Completes Tasks with Accommodations/Modifications and/or Assistive Technology Solutions Currently in Place

Accommodations/Modifications:

Assistive Technology Solutions:

D. Additional Solutions/Services Needed, Including Assistive Technology:

A. Instructional or Access Areas

___ Reading:

___ GEC

___ COM

___ SEC

___ HOM

B. Independent with Standard Classroom Tools:

C. Completes Tasks with Accommodations/Modifications and/or Assistive Technology Solutions Currently in Place

Accommodations/Modifications:

Assistive Technology Solutions:

D. Additional Solutions/Services Needed, Including Assistive Technology:

A. Instructional or Access Areas

___ Math:

___ GEC

___ COM

___ SEC

___HOM

B. Independent with Standard Classroom Tools:

C. Completes Tasks with Accommodations/Modifications and/or Assistive Technology Solutions Currently in Place

Accommodations/Modifications:

Assistive Technology Solutions:

D. Additional Solutions/Services Needed, Including Assistive Technology:

A. Instructional or Access Areas

___ Study/Organizational Skills:

___ GEC

___ COM

___ SEC

___ HOM

B. Independent with Standard Classroom Tools:

C. Completes Tasks with Accommodations/Modifications and/or Assistive Technology Solutions Currently in Place

Accommodations/Modifications:

Assistive Technology Solutions:

D. Additional Solutions/Services Needed, Including Assistive Technology:

A. Instructional or Access Areas

___ Listening:

___ GEC

___ COM

___ SEC

___ HOM

B. Independent with Standard Classroom Tools:

C. Completes Tasks with Accommodations/Modifications and/or Assistive Technology Solutions Currently in Place

Accommodations/Modifications:

Assistive Technology Solutions:

D. Additional Solutions/Services Needed, Including Assistive Technology:

A. Instructional or Access Areas

___ Oral Communication:

___ GEC

___ COM

___ SEC

___ HOM

B. Independent with Standard Classroom Tools:

C. Completes Tasks with Accommodations/Modifications and/or Assistive Technology Solutions Currently in Place

Accommodations/Modifications:

Assistive Technology Solutions:

D. Additional Solutions/Services Needed, Including Assistive Technology:

A. Instructional or Access Areas

___ Aids to Daily Living:

___ GEC

___ COM

___ SEC

___ HOM

B. Independent with Standard Classroom Tools:

C. Completes Tasks with Accommodations/Modifications and/or Assistive Technology Solutions Currently in Place

Accommodations/Modifications:

Assistive Technology Solutions:

D. Additional Solutions/Services Needed, Including Assistive Technology:

A. Instructional or Access Areas

___ Recreation and Leisure:

___ GEC

___ COM

___ SEC

___ HOM

B. Independent with Standard Classroom Tools:

C. Completes Tasks with Accommodations/Modifications and/or Assistive Technology Solutions Currently in Place

Accommodations/Modifications:

Assistive Technology Solutions:

D. Additional Solutions/Services Needed, Including Assistive Technology:

A. Instructional or Access Areas

___ Prevocational/Vocational:

___ GEC

___ COM

___ SEC

___ HOM

B. Independent with Standard Classroom Tools:

C. Completes Tasks with Accommodations/Modifications and/or Assistive Technology Solutions Currently in Place

Accommodations/Modifications:

Assistive Technology Solutions:

D. Additional Solutions/Services Needed, Including Assistive Technology:

A. Instructional or Access Areas

___ Seating, Positioning, and Mobility:

___ GEC

___ COM

___ SEC

___ HOM

B. Independent with Standard Classroom Tools:

C. Completes Tasks with Accommodations/Modifications and/or Assistive Technology Solutions Currently in Place

Accommodations/Modifications:

Assistive Technology Solutions:

D. Additional Solutions/Services Needed, Including Assistive Technology:

A. Instructional or Access Areas

___ Other (Specify):

___ GEC

___ COM

___ SEC

___ HOM

B. Independent with Standard Classroom Tools:

C. Completes Tasks with Accommodations/Modifications and/or Assistive Technology Solutions Currently in Place

Accommodations/Modifications:

Assistive Technology Solutions:

D. Additional Solutions/Services Needed, Including Assistive Technology:

Consideration Outcomes:

___Student independently accomplishes tasks in all instructional areas using standard classroom tools. No assistive technology is required.

___ Student accomplishes tasks in all instructional areas with accommodations and modifications. No assistive technology is required.

___ Student accomplishes tasks in all instructional areas with currently available assistive technology. Assistive technology is required.

___ Student does not accomplish tasks in all instructional access areas. Additional solutions including assistive technology may be required.

Specify any assistive technology services required by this student:

Consideration Checklist Completed by:

Position:

Date:

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Assistive Technology for Students Who Are Blind or Visually Impaired © 2009 American Foundation for the Blind. All rights reserved.


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