Forms

Forms are necessary for a number of reasons: You will need a form to set out expectations for the use and care of AT equipment; forms are needed to document data related to AT use; there is a form that provides proof of eligibility for special materials such as digital versions of books; and signed forms may hold families accountable for how equipment is used at home. When creating any form that families will sign, be sure to have it checked for legality.

Student AT Device Check-out Forms

If students will be taking their devices home, you will need a form that sets out expectations for the use and care of AT equipment when not on school property. Below is a list of items to consider including on the form:

• Identifying information for the student and the equipment
• A statement that the equipment should be used outside of school for educational purposes only as outlined in the student’s IEP
• A statement that the equipment should be used only by the student to which it has been assigned
• An expectation that the family will care for the device and return it to school daily
• An agreement that the family will not modify the equipment
• An agreement that the family will return the equipment to the AT office in the summer and when the student graduates or withdraws from the district

These are some sample forms to review:

• Lincoln Public Schools
• Chicago Public Schools

Personal Device Use at School Forms

In addition, if personal devices will be permitted to be used at school in place of school-owned assistive technology, it may be advantageous to provide a written policy and/or form outlining the expectations regarding this equipment as well. Items to consider including are the following:

• The ARD committee will have sole authority to decide how the student-owned equipment will be used at school
• School personnel have permission to handle and modify the device as deemed necessary to meet the student’s IEP
• Specify who is responsible for upkeep and repairs
• Specify whether the district will take responsibility if the device is lost, stolen or damaged at school

If your district’s Technology Department has a policy regarding personal device use at school, you may want to review these rules and refer to them as appropriate in the AT Department policy as well.

Data Collection Forms

All staff who interact with students using AT should be responsible for collecting data on AT use. To make that process more consistent, it is best to agree on how and what data to collect. Using forms will assist with this process. Any form that reflects the data you are interested in gathering is fine.

Here are a few samples found online:

• WATI's Trial Use Guide Form
• How Do You Know It? How Can You Show It? (See Appendix for forms)
• University of Kentucky's AT Trial Implementation Form
• Illinois Schools Assistive Technology Sample Forms (mulitiple)
• Data Collection Form for up to 5 Goals
• Data Collection Sheet for Speech Therapy
• Editable Data Sheets for SLPs