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created by Cyral Miller

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Student name:
Visual etiology:
Date of last functional:
Field restrictions:
0&M assessment/services:
Vision related IEP goals and objectives:



  1. Is the classroom environment organized into specific areas for different activities? Examples:
  2. Are these areas accessible to your student?
  3. Are there modifications in the environment for your student's visual needs? (e.g. lighting, highlighting, tactual markers, etc.) Examples:
  4. Does the teacher's instructional style reflect an understanding of your student's sensory needs? Examples:

Classroom activities:

  1. Is there a schedule with planned activities for the day?
  2. How is the schedule communicated to your student?
  3. Does the schedule reflect activities that support your student's IEP goals and objectives?
  4. Is your student ACTIVELY participating in instructional activities? Examples observed:
  5. Do the activities reflect appropriate modifications for your student's sensory needs? Examples observed:
  6. Are activities teaching skills rather than just physical maintenance? Examples observed:
  7. Are there opportunities for choice making? Examples observed:
  8. Are activities meaningful for your student? Examples observed:
  9. How are upcoming transitions communicated to your student? Examples observed:
  10. How is your student communicating? Is it appropriate for his/her sensory abilities?
  11. Is your student initiating responses?
  12. Are paraprofessionals and related service professionals trained in the modifications and strategies needed by your student due to his/her sensory abilities?
  13. Are paraprofessionals involved in direct instruction given sufficient supervision and support to appropriately interact and instruct?
  14. What further could YOU do, as a VI professional, to further this student's education?