AT Referral Form
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Name of Student
Name of staff member making referral.
Referring staff member job title
What are the student strengths?
What are the limitations of the student? What "gaps" are you trying to fill?
Please list all of the LOW TECH AT supports/services you have already explored before seeking AT support? For example (pencil grips, graphic organizers). See a comprehensive list on AT website.
Use of Calculator
Use of Computer/Word Processor
1:1 Tablet Type Device
Other, please specify