Professional Documents
Culture Documents
STUDENT INFORMATION
Student Name Grade Date of Birth
CONFIDENTIAL Preschool CONFIDENTIAL
EQUIPMENT
EQUIPMENT AND SOFTWARE TO BE USED STATUS (e.g., owned by school, will purchase, will borrow, etc…)
Cochlear implant Student purchased
IMPLEMENTATION TEAM
NAME (List all individuals who will implement the AT with the student.) ROLE (e.g., administrator, teacher, family member, service provider, etc…)
All teachers and administration
EQUIPMENT TASKS
TASK (e.g., order/procure AT, load software, adapt/customize devices/software, set up PERSON RESPONSIBLE DATE DUE
at home/school, maintain/repair, etc.)
Hearing assistance Student/parent
TRAINING
TRAINING NEED TRAINEES TRAINER DATES & TIMES FOLLOW UP / ALONG PLAN
CLASSROOM IMPLEMENTATION
IEP GOAL CURRICULUM/DOMAIN (e.g., PERSON(S) RESPONSIBLE AT NEEDED TO ACCOMPLISH GOAL (List specific
math, science, PE, art, etc…) AT and customized settings if appropriate)
Student can communicate ALL Student Cochlear implant
HOME IMPLEMENTATION
IEP GOAL CURRICULUM/DOMAIN (e.g., PERSON(S) RESPONSIBLE AT NEEDED TO ACCOMPLISH GOAL (List specific
math, science, PE, art, etc…) AT and customized settings if appropriate)
Student can communicate. Student/parent Cochlear implant
MONITORING/EVALUATION
GOAL INSTRUCTIONAL STRATEGY RECORDING SYSTEM & FREQUENCY PERSONS RESPONSIBLE FOR
(How will you teach student to use equipment (e.g., task analysis recording system; score + or - on IMPLEMENTATION / DATA COLLECTION
and/or how to achieve goals.) data recording sheet)
Student can communicate with sound. LING syllable test hourly ALL teachers