Appendix A: Assistive Technology Assessment Low Incidence Referral
Assistive Technology refers to a device or service that can be used as a tool by students with disabilities to achieve or maintain function. Pre-Referral Procedure – Local Education Agency (LEA) Responsibility 1. Convene an IEP meeting to document the team’s decision to refer the student for an Assistive Technology Assessment. 2. Complete the Assistive Technology Assessment Referral form (DM 127) and obtain the signatures of the person making the referral and the director of special education. 3. Complete the Assessment Plan form (DM 66) and obtain the parent/guardian signature. • The person making the referral should check the box that corresponds to the type of assessment(s) requested. • The parent/guardian should initial each applicable statement listed under the Parental Authorization section. 4. Complete the Authorization for Use and/or Disclosure of Information form (DM 63) and obtain the parent/guardian signature. Specify the receiving agency’s name, if known. If not, leave the field blank. Referral Procedures – LEA Responsibility Forward the following completed documents to the attention of the Coordinator, Transition Services at the DMCS. • DM 127 Assistive Technology Assessment Referral form • DM 66 Assessment Plan form • DM 63 Authorization for Use and/or Disclosure of Information form • IEP or IEP Addendum dated within one (1) year of the referral for an Assistive Technology Assessment • Psycho-educational evaluation dated within three (3) years of the referral for an Assistive Technology Assessment • Any additional supporting information Timelines for Assessment Within five (5) business days of receipt of the completed referral packet, the Coordinator, Transition Services at the DMCS will assign the assessment to an independent assessor who will coordinate the assessment through the contact person named on the referral form (DM 127).
BP 3001 – Low Incidence Funding
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Desert Mountain Charter Special Education Local Plan Area (DMCS) (rev. 09/17)
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