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  1. Name:
  2. Date:
  3. Information on My Etiology
  4. Access to Distance Tasks in School Settings
    1. Examples of tasks:
    2. Strategies and tools I use to accomplish these:
    3. My challenges:
  5. Access to Near and Medial Tasks in School Settings
    1. Examples of tasks:
    2. Strategies and tools I use to accomplish these:
    3. My challenges:
  6. Access to Distance Tasks in Community Settings
    1. Examples of tasks:
    2. Strategies and tools I use to accomplish these:
    3. My challenges:
  7. Access to Near and Medial Tasks in Community Settings
    1. Examples of tasks:
    2. Strategies and tools I used to accomplish these:
    3. My challenges:
  8. Access to Near and Medial Tasks at Home
    1. Examples of tasks:
    2. Strategies and tools I used to accomplish these:
    3. My challenges: