STUDENT INFORMATION Student Name Grade Date of Birth Ansley B. 6th 09/01/2000 School Date AT Plan Review Date Faith Lutheran School 09/05/12 09/07/12 POINT OF CONTACT (Individual assigned to keep the Implementation Plan updated) Mrs. Burns, Resource Teacher EQUIPMENT EQUIPMENT AND SOFTWARE TO BE USED STATUS (e.g., owned by school, will purchase, will borrow, etc…) Timer Will purchase Daily Planner Already purchased Paper filing system Will purchase Recorder Will borrow Locker shelves Will purchase Checklists Mrs. Toms will create using a checklist software and will laminate IMPLEMENTATION TEAM NAME (List all individuals who will implement the AT with the student.) ROLE (e.g., administrator, teacher, family member, service provider, etc…) Mrs. Stoeppelwerth, Mrs. Doty, Ms. Greinke Middle School Teachers Mr. Hibbs Principal, 6th Grade Math Teacher Mrs. Burns Resource Teacher Mrs. Toms 4th Grade Teacher/Tutor Mr. and Mrs. B. Parents EQUIPMENT TASKS TASK (e.g., order/procure AT, load software, adapt/customize devices/software, set up PERSON RESPONSIBLE DATE DUE at home/school, maintain/repair, etc.) Purchase timer, locker shelves, filing crate, dividers Mrs. B. 9/10/12 Set up planner at school/home Mrs. Toms and Mrs. B. 9/12/12 Research checklist sites and create lists Mrs. Toms 9/10/12 Procure recorder Mrs. Burns 9/10/12
STUDENT INFORMATION Student Name Grade Date of Birth Ansley B. 6th 09/01/2000 School Date AT Plan Review Date Faith Lutheran School 09/05/12 09/07/12 POINT OF CONTACT (Individual assigned to keep the Implementation Plan updated) Mrs. Burns, Resource Teacher EQUIPMENT EQUIPMENT AND SOFTWARE TO BE USED STATUS (e.g., owned by school, will purchase, will borrow, etc…) Timer Will purchase Daily Planner Already purchased Paper filing system Will purchase Recorder Will borrow Locker shelves Will purchase Checklists Mrs. Toms will create using a checklist software and will laminate EQUIPMENT TASKS TASK (e.g., order/procure AT, load software, adapt/customize devices/software, set up at home/school, maintain/repair, etc.) PERSON RESPONSIBLE DATE DUE Purchase timer, locker shelves, filing crate, dividers Mrs. B. 9/10/12 Set up planner at school/home Mrs. Toms and Mrs. B. 9/12/12 Research checklist sites and create lists Mrs. Toms 9/10/12 Procure recorder Mrs. Burns 9/10/12 IMPLEMENTATION TEAM NAME (List all individuals who will implement the AT with the student.) ROLE (e.g., administrator, teacher, family member, service provider, etc…) Mrs. Stoeppelwerth, Mrs. Doty, Ms. Greinke Middle School Teachers Mr. Hibbs Principal, 6th Grade Math Teacher Mrs. Burns Resource Teacher Mrs. Toms 4th Grade Teacher/Tutor Mr. and Mrs. B. Parents
etomsassistivetechnology_report.docx