Student Information Form (Technology)

The following is a list of questions that should be answered as part of a technology evaluation.

1. Where do you envision you child/student living when he/she is no longer in school?
2. What technology devices do you envision your child/student using when she/he is in such a setting? (alerting devices, computer)
3. Are there any special leisure time activities or skills your child/student requires as you plan for future placement (e.g. occupy time independently)?
4. Does this student have a caseworker from the Texas Commission for the Blind? If so, have they done any assessments? Do you have copies of the assessments?
5. How do you (teacher/parent) find out about available and appropriate technology devices?
6. What devices would allow your student/child to locate and interact with others within his/her immediate environment (students, teachers)?  
7. Are there times when the student’s communication system doesn't allow him/her to interact with others (eg. braille, tactual signing)?
8. Does the student have the concept of people not in the immediate environment being accessible? (aunt by telephone)
9. If she/he does not have the concept, would it be appropriate to work on developing the concept?
10. Does the student have a vehicle (eg. watch, calendar box, date book) to organize and represent events in his/her past, present, and future? If so please describe.
11. What are some leisure time activities your child/student enjoys or prefers? (eg. playing with toys, swing)
12. Does the student's skill level in math indicate a need for technology (calculators)?
13. How does this student/child communicate requests for objects, actions, or information?
14. How does this student/child reject objects, actions, and social contacts?
15. How does this student/child request simple information?
16. How does this student/child use communication for reporting on past events?
17. Does the IEP contain goals for expanding student skills and use of time concepts?
18. Does the LMA checklist contain items appropriate for deaf/blind (eg. tactual sign)?
19. At what grade level is the student reading successfuly?
20. On the LMA, what was the student's primary and secondary sensory channel?
21. Formal and informal auditory assessments indicate that the student:
    _____ alerts to sounds in the environment
    _____ identifies people or objects by auditory cues alone
    _____ detects speech
    _____ comprehends speech (people in environment, talk boards)
    _____ don't know
22. Did the vocational evaluation yield any needs for technology?
23. Is there an Informal Transition Plan for this student?
24. Is there a current technology assessment on this student?
25. Has this student been referred for an Orientation and Mobility (O&M) evaluation? Did the evaluation indicate any need for technology?
26. Does the student's FM system allow direct connect for computer usage?

Developed 12-01-97 by Sharon Nichols, Texas School for the Blind and Visually Impaired