PHYSICAL ABILITIES: 1. How would you describe the child’s general physical abilities and/or challenges? 2. Are the child’s challenges developmental (since birth) or a result of a traumatic event? 3. Does the child receive: speech therapy yes | no Describe: (school-based and/or private) yes | no Describe: occupational therapy physical therapy yes | no Describe: vision supports yes | no Describe: hearing supports yes | no Describe: yes | no Describe: behavior supports after-school tutoring yes | no Describe: other supports yes | no Describe: 4. Does the child have: a wheelchair (manual/power) yes | no yes | no laptray on wheelchair yes | no If yes, where: braces (hands/feet/body) glasses yes | no hearing aid(s) yes | no If yes, please circle: Left ear Right ear Both ears walker yes | no yes | no stander
PHYSICAL ABILITIES: 1. How would you describe the child’s general physical abilities and/or challenges? 2. Are the child’s challenges developmental (since birth) or a result of a traumatic event? 3. Does the child receive: speech therapy (school-based and/or private) yes | no Describe: occupational therapy yes | no Describe: physical therapy yes | no Describe: vision supports yes | no Describe: hearing supports yes | no Describe: behavior supports yes | no Describe: after-school tutoring yes | no Describe: other supports yes | no Describe: 4. Does the child have: a wheelchair (manual/power) yes | no laptray on wheelchair yes | no braces (hands/feet/body) yes | no If yes, where: glasses yes | no hearing aid(s) yes | no If yes, please circle: Left ear Right ear Both ears walker yes | no stander yes | no
Preassessment-AAC-Form_PED.docx