Bowling Green Independent Schools

BOWLING GREEN INDEPENDENT SCHOOLS

ASSISTIVE TECHNOLOGY ASSESSMENT

TEACHER CHECKLIST

Student Name: ______Today’s Date: ______

Name and title of person completing this checklist: ______

Relationship to student: ______

PART 1 – PRESENT LEVEL OF SKILLS

Directions: Please indicate how well the student performs the following skills when compared to same age peers.

The ARC team has determined this is not an area of concern at this time.
ACADEMIC SKILLS / Weakness / Emerging / Age-Appropriate / N/A
Understand basic cause/effect / ○ / ○ / ○ / ○
Exhibit choice making skills / ○ / ○ / ○ / ○
Demonstrate matching skills / ○ / ○ / ○ / ○
Demonstrate sorting/categorizing skills / ○ / ○ / ○ / ○
Follow simple commands/directions / ○ / ○ / ○ / ○
Has the memory and problem solving skills necessary to accomplish school daily/living tasks / ○ / ○ / ○ / ○
Visually track along a line of print / ○ / ○ / ○ / ○
Identify letters / ○ / ○ / ○ / ○
Read basic sight words / ○ / ○ / ○ / ○
Decode unknown words / ○ / ○ / ○ / ○
Read texts independently / ○ / ○ / ○ / ○
Use appropriate letter formation / ○ / ○ / ○ / ○
Use proper alignment and spacing in his/her written work / ○ / ○ / ○ / ○
Write legibly at a reasonable rate in a reasonable time / ○ / ○ / ○ / ○
Write legible (even if at a slow pace) / ○ / ○ / ○ / ○
Convey personal information in writing (i.e., name, date of birth, address, phone number, etc.) / ○ / ○ / ○ / ○
Write using complete sentences / ○ / ○ / ○ / ○
Write using correct grammar / ○ / ○ / ○ / ○
Spell enough of the words needed to communicate in written form / ○ / ○ / ○ / ○
Identify numbers / ○ / ○ / ○ / ○
Demonstrate 1-to-1 correspondence / ○ / ○ / ○ / ○
Know basic math facts as expected for grade level / ○ / ○ / ○ / ○
Perform math tasks needed for school or daily living (money handling, telling time) / ○ / ○ / ○ / ○
The ARC team has determined this is not an area of concern at this time.
STUDY/ORGANIZATIONAL SKILLS / Weakness / Emerging / Age-Appropriate / N/A
Adequate attention span needed to handle school/daily living tasks / ○ / ○ / ○ / ○
Has the sequencing skills necessary to follow a daily schedule / ○ / ○ / ○ / ○
Start/initiate tasks with minimal prompting / ○ / ○ / ○ / ○
Take notes at the level needed in school and/or daily living / ○ / ○ / ○ / ○
Participate in class / ○ / ○ / ○ / ○
Record assigned tasks / ○ / ○ / ○ / ○
Has appropriate materials/supplies for class activities / ○ / ○ / ○ / ○
Complete assigned tasks within timelines / ○ / ○ / ○ / ○
Follow school/classroom rules / ○ / ○ / ○ / ○
Respect authority / ○ / ○ / ○ / ○
Transition from a preferred activity to a non-preferred activity without incident / ○ / ○ / ○ / ○
Respond well to criticism/feedback / ○ / ○ / ○ / ○
Request assistance when necessary / ○ / ○ / ○ / ○
The ARC team has determined this is not an area of concern at this time.
DAILY LIVING / Weakness / Emerging / Age-Appropriate / N/A
Independently use various clothing fasteners to dress himself/herself / ○ / ○ / ○ / ○
Feed himself/herself independently / ○ / ○ / ○ / ○
Participate in school lunch independently (i.e., go through line, choose food, sit with classmates, etc.) / ○ / ○ / ○ / ○
Maintain personal hygiene necessary for social acceptance / ○ / ○ / ○ / ○
Use restroom independently without supervision / ○ / ○ / ○ / ○
The ARC team has determined this is not an area of concern at this time.
PRE-VOCATIONAL AND VOCATIONAL / Weakness / Emerging / Age-Appropriate / N/A
Perform basic classroom/school jobs independently (i.e., run errands, pass out papers, clean, etc.) / ○ / ○ / ○ / ○
Access/participate in vocational or job activities / ○ / ○ / ○ / ○
Use a computer without modifications / ○ / ○ / ○ / ○
Hold the phone and dial independently / ○ / ○ / ○ / ○
Access everything at a job site (i.e., desk, bathroom, etc.) / ○ / ○ / ○ / ○
Organize and maintain his/her school supplies and materials / ○ / ○ / ○ / ○
Manage his/her time appropriately when working on assigned tasks / ○ / ○ / ○ / ○
Maintain focus and engagement with the academic material presented / ○ / ○ / ○ / ○
The ARC team has determined this is not an area of concern at this time.
RECREATION AND LEISURE / Weakness / Emerging / Age-Appropriate / N/A
Use the playground equipment independently / ○ / ○ / ○ / ○
Participate in group recreational activities, such as sports or group games / ○ / ○ / ○ / ○
Demonstrate appropriate turn-taking / ○ / ○ / ○ / ○
Take part in activities requiring fine motor skills, such as board games, puzzles, art, etc. / ○ / ○ / ○ / ○
Participate in extra-curricular activities, such as clubs / ○ / ○ / ○ / ○
Initiate interaction with peers during play (e.g., join in play or ask a peer to play with him/her) / ○ / ○ / ○ / ○
Indicate preference for certain toys, activities, peers, etc. / ○ / ○ / ○ / ○
The ARC team has determined this is not an area of concern at this time.
PHYSICAL ACCESS TO MATERIALS/ SEATING/ POSITIONING/MOBILITY / Weakness / Emerging / Age-Appropriate / N/A
Climb and descend stairs independently / ○ / ○ / ○ / ○
Sit upright while completing tasks at his/her desk (i.e., not slouched, resting head on desk or hand, etc.) / ○ / ○ / ○ / ○
Maintain appropriate posture while seated and actively engaged in a motor task (i.e., writing, etc.) / ○ / ○ / ○ / ○
Participate in playing and running activities without atypical body postures / ○ / ○ / ○ / ○
Sit on the floor without assuming asymmetrical (i.e., irregular, lop-sided, etc.) postures / ○ / ○ / ○ / ○
Have the motor skills necessary to get around within the school / ○ / ○ / ○ / ○
Participate in physical activities (structured and/or independent) without tripping or stumbling / ○ / ○ / ○ / ○
Navigate within the classroom/school setting without tripping or stumbling / ○ / ○ / ○ / ○
Open heavy doors independently / ○ / ○ / ○ / ○
Maintain balance while performing an activity (i.e., putting on boots, getting up from floor, etc.) / ○ / ○ / ○ / ○
Carry objects while walking independently / ○ / ○ / ○ / ○
Cut and/or handle scissors independently / ○ / ○ / ○ / ○
Use writing utensils (i.e., markers, paint brush, pencil, crayons) independently / ○ / ○ / ○ / ○
Copy materials from a book, board, etc. / ○ / ○ / ○ / ○
Tie shoes, button, snap, and/or use zippers independently / ○ / ○ / ○ / ○
Turn door knobs or handles, water faucets, pages in and a book, and use manipulatives / ○ / ○ / ○ / ○
Use a computer keyboard / ○ / ○ / ○ / ○
Use a computer “mouse” / ○ / ○ / ○ / ○
Draw, form letters, stay on the line, and/or trace / ○ / ○ / ○ / ○
The ARC team has determined this is not an area of concern at this time.
SENSORY (Hearing/Vision) / Weakness / Emerging / Age-Appropriate / N/A
See printed materials presented in the classroom / ○ / ○ / ○ / ○
See toys/objects in the classroom environment / ○ / ○ / ○ / ○
Transfer information from a book, chart, and/or Interactive board to paper / ○ / ○ / ○ / ○
Does the student’s vision allow him/her to freely (and safely) move around the classroom/school setting / ○ / ○ / ○ / ○
Does the student demonstrate normal hearing / ○ / ○ / ○ / ○
Respond to environmental stimuli appropriately (someone knocking on classroom door, fire alarm) / ○ / ○ / ○ / ○
The ARC team has determined this is not an area of concern at this time.
COMMUNICATION / Weakness / Emerging / Age-Appropriate / N/A
Speak to communicate / ○ / ○ / ○ / ○
Others in the school environment are able to understand the student’s speech / ○ / ○ / ○ / ○
Initiate and maintain conversations with peers and adults independently / ○ / ○ / ○ / ○
Participate fully in the classroom discussion / ○ / ○ / ○ / ○
Express basic wants/needs / ○ / ○ / ○ / ○
Respond appropriately to questions/comments / ○ / ○ / ○ / ○

PART II – STUDENT BEHAVIOR

Directions: Indicate the student’s ability in the following areas:

Weakness / Emerging / Age-Appropriate / Comments
Responsible for materials (keeps track of belongings) / ○ / ○ / ○
Handles equipment in an appropriate manner / ○ / ○ / ○
Has necessary materials at appropriate times / ○ / ○ / ○
Trustworthy / ○ / ○ / ○
Can attend to a PREFERRED task for ____ min/sec (indicate number and circle time) / ○ / ○ / ○
Can attend to a NON-PREFERRED task for
____ min/sec (indicate number and circle time) / ○ / ○ / ○
Student can use a keyboard to access word processing applications. Student can type at a rate of ____ words per minute (indicate number) / ○ / ○ / ○

Directions: Describe reinforcers that have been or could be motivating for the student:

Reinforcers / Description
People
Food
Objects
Activities/Use of time
Sound/Movement
Potential Reinforcers
Other:

PART III – ASSISTIVE TECHNOLOGY SOLUTIONS THAT HAVE BEEN ATTEMPTED PRIOR TO REQUEST FOR AT EVALUATION

Directions: Please answer the following questions based on your concern for this student.

What task is it that we want this student to do, that he/she is unable to do at a level that reflects his/her skills/abilities? The task(s) must be relevant to the student’s IEP. ______

What strategies have been tried to enable the student to complete the abovementioned task(s)? You may refer to the following Assistive Technology Resource Guide. (Please note that the following AT Resource Guide is not an exhaustive list).

______

ASSISTIVE TECHNOLOGY RESOURCE GUIDE (adapted from the Georgia Project for Assistive Technology Consideration Checklist Resource Guide)

Task/Participation / Modifications and Accommodations of Task and Expectations
/ Assistive Technology Solutions
Writing / ·  Increased time for completing assignments
·  Decreased length of assignment/number of responses
·  Oral dictation as an alternative to writing
·  Peer notetaker
·  Format of assignment changed to meet need of student - multiple choice, matching word banks, fill-in-the-blank, short answer
·  Word banks, sentence starters, and cloze format writing activities for supports
·  Provide typed outline or typed copy of lecture notes to student prior to delivery for student to use to follow lecture
·  Student highlights key points on printed copy of notes rather than copying/ recording lecture notes
·  Webbing-concept mapping strategy used
/ ·  Pencil grip or other adapted writing aids
·  Adapted paper (bold line, raised line, different spacing, secured to desk, paper stabilizers)
·  Slant board
·  Personal dry erase board
·  Non-slip writing surface
·  Tape recorder or digital recorder for dictated responses and notetaking
·  Portable word processor (e.g. AlphaSmart Neo, The Writer Fusion, etc.)
·  Notetaking device (e.g. Braille, adapted tape/digital recorder, smartboard, Notetaker, Iris Pen)
·  Computer with word processing software with spell and grammar checks (e.g. Microsoft Word)
·  Computer with word processing software and outlining/webbing software (e.g. Inspiration or Kidspiration, Draft:Builder)
·  Computer with graphic-based word processor (e.g. Writing with Symbols)
·  Computer with talking word processing software (e.g. Write Out:Loud, Classroom Suite, Talking Word Processor)
·  Computer with word prediction software (e.g. Co:Writer, WordQ)
·  Computer with graphic based word processor (e.g. Writing with Symbols)
·  Scanner and computer with form filling software to create electronic worksheets
·  Computer-based advanced reading and writing aids (e.g. Kurzweil 3000, WYNN, Read & Write Gold)
·  Adaptive input hardware and/or software (e.g. keyguard, keyboard utilities, enlarged keyboard, touchscreen, on-screen keyboard, trackball, switch access, voice dictation software, Braille input)
·  Adaptive output solutions (screen enlargement, text or screen reading software)
Spelling / ·  Peer/adult assistance for difficult to spell words
·  Personal or custom dictionary
·  Problem word list
·  Reduce number of spelling words
·  Increased time for completing assignments / ·  Personal dry erase board for practice
·  Tape recorder with difficult to spell words recorded
·  Hand-held spellchecker without auditory output (e.g Merriam-Webster Dictionary and Thesaurus)
·  Hand-held spellchecker with auditory output (e.g. Speaking Merriam-Webster Dictionary and Thesaurus)
·  Portable word processor with built-in spellchecker (e.g. AlphaSmart NEO, The Writer Fusion)
·  Computer with word processing program with spell check feature (e.g. Microsoft Word)
·  Computer with talking word processing software containing speaking spell check (e.g. Write Out:Loud, Classroom Suite, Talking Word Processor)
·  Computer with word prediction software
Reading / ·  Peer/adult reading assistance
·  High interest, low reading level materials
·  Increased time for completing reading materials
·  Decreased length of assignment
·  Simplify complexity of text
·  Color coding to emphasize key points (highlighting)
·  Custom vocabulary list
·  Increase print size of materials through photocopying / ·  Page fluffers (i.e., adaptations made to books or other reading material that make pages more accessible to turn)
·  Slant board and book holders for positioning books