ASSISTIVE TECHNOLOGY IMPLEMENTATION PLAN STUDENT INFORMATION Student Name Grade 6 Date of Birth XXXXXXX XXXXX School Date AT Plan Review Date Middle Goal for use of AT: How will we know the trial is successful? What level of achievement is reasonable during the trial period? How will we know if the trial is not working? SCHOOL CONTACT (Individual assigned to keep the Implementation Plan updated) IMPLEMENTATION TEAM NAME (List ALL individuals who will implement the ROLE (e.g., administrator, teacher, family member, AT with student). service provider, student, etc.) EQUIPMENT EQUIPMENT & SOFTWARE TO BE USED STATUS (e.g., owned by school, will purchase, will borrow from district library, etc.)
ASSISTIVE TECHNOLOGY IMPLEMENTATION PLAN STUDENT INFORMATION Student Name XXXXXXX Grade 6 Date of Birth XXXXX School Middle Date AT Plan Review Date Goal for use of AT: How will we know the trial is successful? What level of achievement is reasonable during the trial period? How will we know if the trial is not working? SCHOOL CONTACT (Individual assigned to keep the Implementation Plan updated) IMPLEMENTATION TEAM NAME (List ALL individuals who will implement the AT with student). ROLE (e.g., administrator, teacher, family member, service provider, student, etc.) EQUIPMENT EQUIPMENT & SOFTWARE TO BE USED STATUS (e.g., owned by school, will purchase, will borrow from district library, etc.)