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Name:
Age:
Grade:

Change Placement: (what grades will student move to a  new school)

Future Goals: (what are the student's goals for the future)

Future Placement (where will the student be in 1, 3,and 5 years)

Typing Rate

  • Repeat same sentence
  • Generate own information
  • Gross words per minute
  • Errors-keyboarding
  • Errors-spelling

Brailling Rate on braille writer and any electronic device

  • Repeat same sentence
  • Generate own information
  • Gross words per minute
  • Errors-Brailling
  • Errors-spelling

Keyboarding skills (obtain typing information on familiar keyboard and migration keyboard)

  • Number Row
  • Shift Number Row
  • Punctuation and Shift Punctuation
  • Function Keys
  • Numeric Keypad
  • Modifiers-Control, ALT (Command Key for the Macintosh)
  • Modifiers-Caps Lock, Shift
  • Movement-Tab, Home, End, Arrows, Page Down, Page Up
  • Others-Backspace, Insert, Delete, Print Screen, Pause, Scroll Lock

Reading Rate

  • Regular
  • Large Print
  • CCTV
    • Without filters
    • With filters
  • Low Vision Aids
  • Computer Screen
    • Without filters
    • With filters
  • Paper Braille
  • Refreshable Braille

Reading distance

  • CCTV
    • Without filters
    • With filters
  • Computer Screen
    • Without filters
    • With filters

Listening

  • Auditory Discrimination
  • Sentence Repetition
  • Auditory Comprehension

Describe the devices (synthesizer) used, learning style, motor planning, following directions, memory, time involved