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STUDENT INFORMATION
Student Name
Sydney
Grade
K
Date of Birth
School
Wilcox County Elementary School
Date
9/16/13
POINT OF CONTACT
EQUIPMENT
EQUIPMENT AND SOFTWARE TO BE USED
SmartTable
owned by school
Flash Drive
owned by school
EQUIPMENT TASKS
TASK (e.g., order/procure AT, load software, adapt/customize devices/software, set up
at home/school, maintain/repair, etc.)
PERSON RESPONSIBLE
DATE DUE
Susan
9/20/13
customize device
Angela
maintain/repair
IMPLEMENTATION TEAM
NAME (List all individuals who will implement the AT with the student.)
Angela
Chandy
SpEd Para-Pro
Susan
Technology Teacher
Matthew
TRAINING
TRAINING NEED
TRAINEES
TRAINER
Angela, Chandy,
Matthew
Angela, Chandy,
Matthew
Susan
as needed
Susan
as needed
CLASSROOM IMPLEMENTATION
IEP GOAL
CURRICULUM/DOMAIN (e.g.,
math, science, PE, art, etc)
PERSON(S) RESPONSIBLE
math
Angela
SmartTable
PERSON(S) RESPONSIBLE
HOME IMPLEMENTATION
IEP GOAL
CURRICULUM/DOMAIN (e.g.,
math, science, PE, art, etc)
MONITORING/EVALUATION
GOAL
INSTRUCTIONAL STRATEGY
Angela
Angela