Assistive Technology and Funding Proposal

McStraw 1

Assistive Technology and Funding Proposal

SBU Evaluator: Samantha McStraw
Contact Information:
mcstrasl14@bonaventure.edu

SBU Professor: Dr. Diana Lawrence-Brown

Contact Information: 716-375- 2165;
dlawrenc@sbu.edu

II. The Learner:

A. Background
1. Students name: Maddie
Attached Referral form. Appendix A
2. Date of birth, age, grade level: Maddie was born on August 8,

2004. She is 11 years and 2 months old, and in the 6th grade.
3. Reason for referral: Maddie struggles with communicating her

feelings to adults when she becomes frustrated. When she

becomes frustrated, she will often shut down and cry or make noises
at her work or adults. She will often curse at people if she is
frustrated.
4. Instructional reading level: According to the STAR Assessment of

Reading, Maddie achieved a scale score of 571. This places her at

a grade equivalent of 5.2 and in the 32nd percentile rank when
compared to her peers.
5. Students IQ Score: Maddie has not been given an intelligence

test. However, based on observation of her in the classroom and of

her work during ELA a best estimate of her IQ score would be in the
Mild Intellectual Disability (55-70) range. This estimate comes from
observations in the small setting classroom in which she is placed for
the majority of the day. The estimate also reflects her abilities in
reading and math on a day-to-day basis. Maddie is in an 8-1-1
setting for Math and Reading, as well as, Science.
6. Type/Level of exceptionality (e.g., from IEP): Maddie is classified

with Other Health Impairment. Maddie has been diagnosed with

Autism, Attention Deficit Hyperactivity Disorder, and Operational
Defiant Disorder.
7. Family/Cultural Information: Maddies primary language is

English and she is of European-American descent. Maddie comes

from a single-parent family and lives with her mother.

Assistive Technology and Funding Proposal

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B. Students present levels: Appendix B

1. Complete and attach the relevant WATI section checklist(s) for

the priority area identified in the referral, e.g., writing, reading

(includes spelling), math, learning and studying, etc.
Use this to help you refine your understanding and descriptions of
the student's abilities (below and throughout the report). If there
appears to be no WATI checklist that is relevant to the priority
interfering factor, see me right away.
2. Academic: Use the WATI, observations, interviews, record and

work sample reviews, and other formal or informal assessments to

complete the table below.
Subject Area

Interests &
Strengths:
Preferences Specific
skills/concepts
that the
student has
achieved
1. Reading (at
Maddie
Maddie has
least decoding
loves to
great verbal
and
read about comprehension
comprehension) cats and
skills.
dogs.

Needs: Specific
skills/concepts
that the student
lacks.

Most
Recent
Report
Card
Grades

2. Writing
(spelling and
composition
skills)

Maddie
loves to
write about
many
topics.

Maddie would
prefer to
verbalize
comprehension
rather than
writing.

She struggles
with transferring
coherent
thoughts onto
paper.

3. Math

Maddie
likes not
having a
lot of

Maddie has a
basic
understanding

Maddie often
89% in
needs adult
Math
support in math.
She doubts

Maddie often
87% in
needs support
ELA
for written
comprehension.

87% in
ELA

Meeting
Age/Grade
Level
Expectations?
(yes or no)
Student is
meeting
grade level
expectations
with the
modified
curriculum
(pace) in a
small setting
classroom.
Student is
meeting
grade level
expectations
with the
modified
curriculum
(pace) in a
small setting
classroom.
Student is
meeting
grade level
expectations

Assistive Technology and Funding Proposal

Subject Area

4. Science,
Social Studies

5. Supplemental
area (from list
below): Art

Interests &
Strengths:
Preferences Specific
skills/concepts
that the
student has
achieved
homework
of many basic
in Math
concepts.
class.

Maddie
likes
learning
new
vocabulary
in Science.
She also
like
learning
about
Egypt and
Greek
Gods and
Goddesses
in Social
Studies.
Maddie
likes to
draw cats
and dogs in
Art class.
She also
likes to
paint when
given the
chance.

Maddie works
well in small
group
activities. She
also likes to
participate in
these small
groups.

Maddie is a
very creative
girl. She likes
drawing and
painting.

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Needs: Specific
skills/concepts
that the student
lacks.

herself when
working
independently
and during her
thought
process.
Maddie also
struggles with
higher
concepts and
the pacing of
General
Education.
Maddie needs
extra time to
complete
written
activities. This
will often lead
to frustration on
an assignment.
She does give
some attitude
toward adults
when she
becomes
frustrated.
Maddie does
become
frustrated when
she does not do
an assignment
perfectly. She
will often erase
until she thinks it
is perfect.

Most
Recent
Report
Card
Grades

Meeting
Age/Grade
Level
Expectations?
(yes or no)
with a
modified
curriculum
(pace) in a
small setting
classroom.

In
Social
Studies
Maddie
has a
81%

She is
meeting
grade level
expectations
in Science
and Social
Studies.

In
Science
Maddie
has an
80%

92% in
Art

Student is
meeting
grade level
expectations
in General
Education Art
Class.

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Supplemental areas (choose at least one): Foreign languages, arts, cognitive

skills (e.g., reasoning ability), independent living skills, preferred learning
modalities/multiple intelligences, study/test taking skills.
3. Social/Communication: Maddie does not communicate her

thoughts and feelings well. She does not understand humor very
well and will sometimes ignore a joke if she does not understand.
Maddie is a very caring girl and always willing to be helpful to her
classmates and adults. Maddie is also very encouraging and
thoughtful. Maddie has some appropriate interactions with her
peers but is lacking as well. At times, Maddies behaviors negatively
impact her performance at school. Maddie needs frequent
reminders to use school appropriate language with peers and
adults. Maddie will also sometimes hiss or make other noises at
peers and adults. Maddie does not participate in extra-curricular
activities at school. It is unclear if she does participate in activities in
the community. Maddie does show some hesitation to try new tasks.
She does eventually try these tasks, however it takes her some time.
4. There are no physical concerns for Maddie at this time. Maddie is

a healthy girl and often brings snacks to school to have throughout

the day. Maddie is sometimes hesitant to participate in physical
education but does not completely refuse.
C. Students Individual Goals: Maddies individual goals are as follows:
1. Maddie will display school appropriate behaviors, encompassing the
entire school day, in a variety of settings in 3 out 5 days for four
consecutive weeks. Behaviors include, though are not limited to,
remaining focused/ on task, using school appropriate language, following
instructions, and engaging in appropriate interactions with peers. Progress
will be reported to parent quarterly, consistent with school district report
cards.
2. Given targeted instruction and assistance, Maddie will increase her
math skills, achieving a scaled score of 640 or higher on the STAR
Assessment of Math. Maddies baseline score is 627.
3. Maddie will us appropriate I feel statements to express herself when
frustrated, mad, or upset with not more than one verbal prompt.
According to Maddies IEP, she will receive Special Class placement in an

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8-1-1 classroom 5 times a week for 2 hours and 35 minutes of the day. She
will also receive Counseling services 3 times a week for 30 minutes each.
D. Current Placement and History of Services:
1. Current Placement: Maddie attends an 8-1-1 classroom for 3

periods of the day.

She is in this placement for Science, Math, and Reading. In Science,
there is one 1:1 aide for another student in the classroom, as well as
the special education teacher. All of the students in the classroom
have disabilities. There are 6 students in this Science Class in the 8-11 classroom. Accommodations are made by the special education
teacher to modify the pace of material covered in the curriculum.
This classroom is on the third floor of the school. It is located near the
bathrooms and near the stairs and elevators. Maddie is in a
different 8:1:1 classroom for Math and Reading. In this classroom,
there is one classroom aide and one 1:1 aide. The same
modification is being made in this classroom. This classroom is
located on the first floor of the school near the cafeteria and
computer lab. Both classrooms support push in and pull out services
for. These classrooms also meet the needs of all students IEP goals.
The school that Maddie attends is rural, but in a city. Many students
grow up in poverty.
2. History of Classification and Services: Maddie has been

receiving services since the first grade. Specific services were not
provided to evaluator. Only services received this year were
provided to evaluator.

E. According to Maddies IEP, annual goals, Maddie is to use appropriate

school language and I feel statements when she is frustrated, mad, or
upset. This is an educational priority for Maddie. Maddie reports to her
teacher that she would like to go to college one day but she is not sure
where she would like to go or even for what. She mentions to her teacher
that she likes cats and dogs, as well as school. With support from her
teachers, Maddie will be successful in school and could achieve her
goals. Maddies mother expresses no concerns for Maddie during the
school day. Maddies councilor expresses concerns for communication
skills and using appropriate school language and I feel statements.

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F. Maddie has no level of expertise with assistive technology because she

has never been introduced to assistive technology to help her with her
annual goals in communication. Maddies teacher has some expertise
with the iPad and application. She will train Maddie with this, as well as
learn along the way.
G. Maddie would mostly benefit from using assistive technology as a form
of communication to express her frustration, anger, and other feelings that
negatively affect her performance at school. The teachers are receptive
of using assistive technology as long as she is able to us it in relation to
verbalizing. She uses this device to assist her in bridging the gap of not
knowing how to express her feelings and frustrations.
H.
III. Analysis of the General Education Environment
A. Targeted General Education Class: The target class for Maddie would
include 6th grade students in the 6th grade classrooms for Reading, ELA,
Math, Social Studies, and Science. There would be approximately 20
students in each of these classrooms. There would be 6 out 20 students in
the classroom with disabilities and 14 out of 20 students without disabilities.
In these classes there would be one general education teacher and one
support staff in the class for students with behavioral problems. The school
is in a rural community where the students often grow up in poverty. The
general education classrooms generally follow the NYS Learning Modules
aligned to the Common Core Learning Standards. These modules are
scripted and are expected to be followed directly or adapted slightly.
B. What teaching and assessment methods are used most often by the
general education teacher(s) involved? The general education teacher
often uses Lecture, discussion, cooperative learning, and written
assignments. The lectures in the general education classes are often
followed by discussion of content. After discussion, students often do a
cooperative learning activities and written assignments. For the purpose of
this project, the General Education English class will be a focus. This
English classroom generally follow the NYS Learning Modules aligned to

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the Common Core Learning Standards. These modules are scripted and
are expected to be followed directly or adapted slightly. There are some
modifications to the Modules based on student interest and student
achievement on mid-unit assessments or post assessments.
C. What reading level is expected of students in this classroom?
1. The general education ELA teacher expects students to be able to
read and comprehend grade 6 materials. The state expects all the
students to be able to read at this level on state tests. Students are
able to read at independent reading levels when reading
independently outside of class.
2. Maddies Lexile score is 780L according to the STAR Reading
Assessment. The Lexile range for this score is 580L-840L. The first book
that was selected was Matilda by Roald Dahl. This novel is one that
Maddie has been reading during her independent reading time.
This novel has a Lexile of 840. Maddie enjoys this book and selected
it on her own. She enjoys fictional stories.
Percy Jackson and the Olympians: The Lightening Thief is the
second book chosen for the readability analysis. This novel has a
740 Lexile score. This novel is one that follows the NYS Reading
Modules for the 6th grade. Maddie enjoys reading this novel in class.
To find the Lexile scores of these books I was able to use the
Lexile.com website.
D. What tasks are expected of most students to be active participants in this
classroom?
In this English class, students are expected to do homework daily.
Each day the teacher reviews the homework from the previous
night. The start of each class is to go over the homework by calling
on a volunteer. Each student is expected to do this homework each
night. Students are then required to follow along in the book as the
teacher reads a novel. This novel goes along with the NYS Learning
Modules. The students are also expected to answer comprehension
questions at the end of each reading. Students are expected to do
all comprehension questions by the end of the class or if there is not
time, time is given the next class. Students are expected to control
their behaviors in a manner that keeps the environment safe.

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E. What is the physical capacity of the classroom in regard to AT?

1. What type of computers or tablets are available for students use?
i. Each student has their own personal laptop loaned to them
by the school. Each student is expected to bring their laptop
with them each day. The students do not use their laptops
every day, however, when they do they are being used
about 20 minutes each time. During this English class, the
students are able use their laptops after all of their homework
is finished. There is also a touch screen TV available in the
classroom for interactive group work and instruction.
2. Is there printer access? Is it in the classroom or remote? What
platforms are supported (e.g., Windows, iOS, etc.)?
i. There is a printer in the classroom. Students are able to use
the printer when needed. The laptops are also wirelessly
connected to a printer in the library. Students are able to print
to that printer when given permission. Most often students are
expected to use the printer in the classroom.
3. Is wired or wireless Internet access available?
i. Wireless internet is available, but students have limited
access. There are blocks set up through the network to
prevent students from being on inappropriate websites.
4. Is space available for additional AT devices? Are electrical outlets
available for AT devices?
i. There is plenty of space available for additional AT devices.
There are few outlets located in the classroom however, there
are many in computer labs and the library.
IV. Access to the General Education Curriculum/Environment
A. Overview of Interfering Factors:
a. Factors that interfere with Maddies participation and access to
appropriate education in the general education
curriculum/environment is the pacing of the curriculum. Maddie
needs to have extra time on her assignments due to the time it
takes her to process some information and the time it takes her to
write her coherent thoughts. Maddies behaviors also interfere with
general education curriculum and environment. Maddie will often
become frustrated with some of the pacing and transitions in the

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general education environment and curriculum. This leads to the

use of inappropriate language and behaviors such as hissing and
making noises at adults and peers. The negatively affects Maddies
success in the general education curriculum and environment.
B. Priority Factor being Addressed:
a. After reviewing the interfering factors in the success of Maddies
day in the general education curriculum and environment, the top
priority for analysis/intervention with assistive technology plan is
Maddies ability to communicate her feelings and frustrations
appropriately. This would help Maddie become successful in the
general education curriculum and environment. If she struggles with
expressing her feelings, this will continue to be a barrier for her in the
general education curriculum and environment.
b. On November 3, 2015, Maddie was observed in the General
Education English Class for one period (40 minutes). The attached
form in Appendix C will show the number of times Maddie exhibits
inappropriate behaviors when she becomes frustrated. This form will
also show the number of times Maddie expresses her frustrations in
that 40 minute time period. During this English class, Maddie
became frustrated with transitions from one activity to the next.
Maddie was not finished with the activity nor was she ready to
transition. This caused her to use inappropriate school language 4
times in a 1 minute frustration block. Maddie was also using
inappropriate behaviors (hissing) during this time. This caused
Maddie to transition longer than it would have if she did not
become frustrated. After about 2 minutes, Maddie was able to
express that she would like to finish the first activity before moving
on to the next. After expressing this, she was able to finish the
activity.
V. Recommendations:
A. Specific Device & Rationale (why you are recommending this device
over alternatives you considered):
1. The assistive technology that is being recommended for this
student is an Application available for free from the Apple Store
and the Google Play Store, that the student is able to download
directly to her iPad Mini. The name of this application is Touch and
Speak: Autism AAC. The purpose of using the application with this
student is to increase her communication skills when she has
become frustrated. This application is a form of communication for
students who struggle with communicating verbally. The application

Assistive Technology and Funding Proposal

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has programmable buttons that allow you to change the words

and the picture. This application also allows you to record your own
voice. For this student, it is a perfect way to allow her to
communicate verbally when she is not feeling comfortable or when
she becomes frustrated. For the purposes of this project I will be
conducting a funding proposal for an iPad Mini device. I have
chosen to do the iPad Mini because the student already owns this
device.
2. Device Evaluation: How does the device measure up in terms of
the following factors:
a. According to Tim Stevens
(http://www.engadget.com/2012/10/30/apple-ipad-mini-review/) ,
the iPad Mini goes above and beyond what customers thought it
would be. The joy of a 7-inch tablet is walking across the office or
the airport, holding the slate in one hand while tapping away at it
with the other (Stevens, 2014). This is important for this students day
in school while she is walking around with books from floor to floor
and classroom to classroom. She is not going to be comfortable
with carrying around a tablet that is much bigger or heavier. The
durability of the iPad Mini is perfect for this student because it only
weighs 0.68 pounds. It is also thinner (7.2 mm) than the iPad itself
(9.4mm). This is important because this student can carry the iPad in
a folder or small purse that she is able to carry around all day long.
The iPad Mini also shows more battery life using WiFi. The iPad Mini
will last approximately 12 hours and 34 minutes. Compared to the
iPad, the iPad mini seems to be more durable and more reliable as
far as mobility.
b. Every Apple product comes with a one year warranty that does
not include damage. However, there is an option to purchase an
extended Apple Repair plan. This will cover two incidents of
damage for a cost of approximately $49. There are no loaners or
trial periods available.
c. The iPad Mini damage is not covered under this one year
warranty. In order to get repairs done through the company there
would need to be a service repair submitted and an out of pocket
expense of approximately $49, depending on the product.
Updating the iPad mini will happen automatically if the iPad is
connected to WiFi.

Assistive Technology and Funding Proposal

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c. Students using the iPad Mini will need to have functional fine-motor
skills in order to use the touch screen. Students will also need to
have finger-eye coordination to be able to see where on the
screen your finger is pointing, to be able to tell your finger where to
point. Students will also have to understand that not all technology
works the way we intend it to all the time. Students will have to have
some patience.
e. The iPad Mini is age appropriate for this student. The age
appropriateness for an iPad Mini would be when the child has
developed fine motor and gross motor skills to be able to carry the
iPad and use the iPad appropriately. The iPad Mini is smaller than
the regular iPad. This would be appropriate for students to carry
around in a small bag or even in a protective folder.
3. Cost:
Item:
iPad Mini 16GB
iPad Mini 64GB
iPad Mini 128GB
Insurance: Apple Care+

Smart Protective Case

Silicone Protective Case
Shipping

Cost:
$399
$499
$599
Included in the first two years. It
is $49 for each product each
time a service plan has been
submitted.
$39
$59
FREE

The cost of the iPad Mini without accessories is based on the size of
gigabytes needed. This comes with a power cord and adapter.
There is also an option of getting a silicone protective case for $59
or a Smart protective case for $39. This would be based on
preference. There is free shipping for this product. After taxes and
no accessories, the total cost of this product is $430.92.
4. Alternative devices that have been considered include low/no
tech options. Using a notebook to communicate the students
feelings and frustrations was considered. The student would be able
to write down her frustrations before communicating them to the
teacher or other students. The student was unsure of how to write
down what she was feeling. This caused more frustrations with trying

Assistive Technology and Funding Proposal

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to communicate how she was feeling and her frustrations. This lead
to another alternative device; the iPad Mini.
5. The student will benefit from the use of this device in an
interpersonal way. The student will be able to communicate with
others how she is feeling and her frustrations. The student will use the
device to communicate first and then repeat what she is feeling.
This will help the student convey what she is frustrated about and
how she is feeling throughout the day. This student will be using the
iPad Mini in all of her classes. She will carry the device with her
throughout the day in school. The device may also be used at
home if the students mother sees necessary. However, it has been
expressed that Maddie does not show struggle with expressing
frustrations at home. This device will provide Maddie with an
appropriate way of communicating her frustrations and feelings in
school. How will the device increase access by the student to an
appropriate education in the general education environment?
B. Skills and Training for Student (6 pts.)
1. The current IEP goal being met using this device is: Maddie will
display school appropriate behaviors, encompassing the entire school
day, in a variety of settings in 3 out of 5 days for four consecutive weeks.
Behaviors include, though are not limited to, remaining focused/on task,
using school appropriate language, following instructions, and engaging
in appropriate interactions with peers.
2. In order to facilitate the students success of using this device she
will need to be trained in how to use the Application on the device. The
application is not difficult to understand. Maddie will be trained in one
week using the device and will have supports throughout the day that will
allow her to ask for assistance when needed. Maddie is followed by a
special education teacher in each of her classes for behavioral support.
This will allow her to ask for assistance when needed with the device and
the application.
C. Evaluation: Quantitative data would include meeting the IEP Goal. The
student will be observed (qualitative data) during the school day in all of
her classes. The teacher will use a tally chart to mark the number of times
the student uses the device when she becomes frustrated. The teacher
will also write any comments that affect the students school day with the
device or with any frustrations. An attached example of this tally chart
can be found in Appendix D.
D. Skills and Training Needed By Others:

Assistive Technology and Funding Proposal

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The teachers that are with Maddie in her school day are already trained
in iPad software. Each teacher has their own iPad for classroom use. The
teachers may need to be trained in using the application and knowing
how to change the words on the communication page or how to record
and change the pictures. This can happen with the student training. The
training of the student and the teachers at the same time will help the
student feel more comfortable. This training can be provided by the
evaluator of this project. The evaluator can teach the student and
teachers how to use the application. The application will update
automatically through WiFi as long as the students device is connected.
E. Exploration of Specific Funding Sources, including school and specific
non-school options.
1. The device is not needed for a free appropriate education in the least
restrictive environment because there are different ways of creating the
same outcomes of this device. For example, the student could use picture
cards to communicate her frustrations and feelings throughout the day.
This student could also write simple sentences down to communicate at
first then explain after she has written. The reason this device has been
recommended is because the student already owns the iPad Mini.
2. Also include at least two specific funding sources other than the
school (or parents); use the table below.
NOTE: You will need to contact the funder directly to thoroughly complete
this section (you are unlikely to find all of the information needed on their
website). Funding sources included here must be a good match for the
student and the device.
Funding Sources

Types of
devices/projec
ts funded

Who is eligible to
apply?

Amount
Available (e.g.,
average award)

Application
deadline

AutismSpeaks.org
Autism Cares iPad
Grant

iPads

Parents/Guardians of
children who have
ASD and individuals
who have ASD.

The award given

is the iPad to the
individual in
which the
application has
been filed for.

There is no
deadline for
the
application.

Contact
information
(name,
address,
phone, e-mail,
web address)
https://www.a
utismspeaks.or
g/AS-cares

Autism
Speaks
Offices
New York
1 East 33rd
Street
4th Floor

Assistive Technology and Funding Proposal

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New York, NY
10016
Phone: (212)
252-8584

ClassWIsh.org

Any assistive
technology
can be funded
through this
site. There is
also a donation
available for
this site in
which
teachers.
Family, friends,
etc, can
donate to help
pay for the
device.

Any K-12 teacher or

school is able to make
a wish for their school
or classrooms.

The award given

is the amount
that is donated
to the school or
to the teacher.

There is no
deadline for
the
applicatoin.

http://classwis
h.org/
ClassWish, Inc.
401 Seventh
Avenue
Office level B
New York, NY
10001

Student Project Disclaimer: Readers of this report are asked to interpret the
results and recommendations with the understanding that it has been
developed as a project for graduate-level assistive technology course. The
author is a qualified teacher in an advanced academic program; the contents
may be limited by the as-yet-developing expertise of the author, time limitations
of the course, etc.
Optional Extra Credit (up to 5 pts.): Try out the recommended assistive
technology with the student. Describe what happened, and what you think
should happen next.
For the first two days of this Maddie really responded well. She was using
the device approximately 2-3 times that she became frustrated. She is still
working on repeating the communication. She does still show some frustrations
but does not completely shut down after she becomes frustrated. She is also
prompted to use the iPad application after she is prompted to verbalize what is
frustrating her. After Maddie reaches her goal for the day, she is given an
incentive. Maddie is able to use her iPad during Free Time at the end of the day.
She is allowed to play games just like the other students do on their laptops.
Maddie does not like to use her laptop and seems to be afraid of it. This was
another reason for suggesting the use of her iPad Mini.

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Overall, I think the implementation of this application has shown some

success. Maddie seems to be responding well to the assistive technology. She
does, however, still need more practice with this.

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Appendix A

Referral for SBU Individual Assistive Technology Evaluation

(if more space is needed, please use the back or attach separate sheet)
Date: 10/28/15
a. Name of student: Madeline

Age: 10:3

SBU Evaluator: Samantha McStraw

b. How would the parents like the student to be referred to in SBU class assignments and discussions?
___ Use the student's real name
___ Use the student's real name for the evaluation report only
___ Parents' preferred pseudonym: __________________________________________________
If the parent's preference is unknown, the evaluator will assign a pseudonym. Evaluator-assigned
pseudonym: _____Maddie_______________________
c. Reason for referral: Maddie has been diagnosed with Autism. She has difficulty expressing her
feelings and frustrations to adults. When she is asked how she is feeling, Maddie will ignore and
sometimes hiss at the adult. Maddie is being referred for Assistive Technology to help her overcome these
challenges of not being able to express her feelings and frustrations appropriately.

Particular areas of interest/concern (check all that apply):

___ Reading (decoding)
___ Reading (comprehension)
___ Writing (spelling)
___ Writing (composition)
___ Computer access (e.g., being able to use the keyboard or mouse)
_x__ Communication skills
___ Independent living skills
___ Organization/study skills ___ Other:

___ Math
___ Writing (letter formation)
___ Recreation/leisure skills

d. Name and contact information (address, phone number, e-mail) for person making referral:
Samantha McStraw, mcstrasl14@bonaventure.edu
How did you hear about assistive technology evaluations through SBU?
Dr. Lawrence-Brown
e. Name and contact information (address, phone number, e-mail) for parent:
Patricia Bellreng
f. Name and address of school:
Olean Intermediate Middle School
401 Wayne St
Olean NY 14760
g. Name of administrator: Mr. Trietley
h. Contact information for administrator (phone number & e-mail):

Assistive Technology and Funding Proposal

McStraw 17

i. Name of teacher: Mr. Korzeniewski

j. Contact information for teacher (phone number & e-mail):
k. To whom should the evaluation report be distributed?

_x__ Parents
_x__ Teachers, therapists
___ Others (list)
l. Student's Current Placement: Type of class, location, number & age-range of classmates, number of
students with and without exceptionalities, number of staff, and by whom the class is primarily taught
(general education, special education, &/or gifted education teacher):
Student is currently in a small classroom setting (8-1-1). There are 8 students in her class; 6 sixth
graders and 2 seventh graders. This student is in a small classroom setting for Math, Reading, and Science
with her classmates. She is in the classroom with all the students during guided study hall. She sees two
different special education teachers for Math/Reading and Science.

Other important environments (e.g., home, community-- optional unless this is the primary environment
of interest for the evaluation). Include type of environment, location, number & age-range of peers,
number of peers with and without exceptionalities, number & type of staff (if any):

m. Exceptionalities (check all that apply)

_x__ Disabilities
___ Speech/Language
___ Hearing Impairment
___ Cognitive Disability
___ Developmental Delay
_x_ Autism
_x_Other Health Impairment
___ Orthopedic Impairment (type):

___
___
___
___

Vision Impairment
Tramatic Brain Injury
Behavioral/Emotional
Other (describe):

___ Specific Learning Disability in ___ reading ___ written language ___ math ___ other:
Has the student been formally identified as having a disability by the school?
_x__ Yes ___ No If yes, include specific IDEA classification (from IEP): Other Health
Impairment
___ Gifted/Talented in _______________ __________ _____________ __________ __ (list areas).
Has the student been formally identified as gifted/talented by the school? ___ Yes ___ No
n. Current Services
Type of service
Aide
Counseling Psychological
Counseling
Gifted Education Teacher

Occupational Therapy

Amount
(hours/week)

Location

1x weekly/ 30 Mins

Counselors Office
___ Push-in (to general education class)
___ Pull-out (to resource room)
___ Self-contained
___ After school program

Assistive Technology and Funding Proposal

Other:
Parent Counseling and Training
Physical Therapy
Special Education Teacher

McStraw 18

1x weekly/ 30 Min
1x weekly/ 20 Min
Small group

Counselors Office

5x weekly

__x_ Push-in (to general education class)

___ Pull-out (to resource room)
___ Self-contained

Speech/Language
o. Any medical concerns? Include chronic health problems, allergies, etc. that the evaluator should be
aware of.
Currently taking medication for Autism, ADHD, and ODD.

p. What assistive technology is currently in use? How effective is it?

None.
q. What assistive technology has been tried previously, but is not used currently? How long was it
tried/used? Why is it no longer being used? (Use the back or separate sheet, if necessary.
None.

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McStraw 19

Appendix B

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Appendix C
November 3, 2015

Number of times Frustration

occurs

Behaviors seen while

frustrated

English Class
40 Minutes

Activity 1: 3 times

Hissing, cursing at book,

crying

Activity 2: 2 times

Cursing at assignment, took

longer to transition (2
minutes), cursing at
teacher

Activity 3: 2 times

Cursing at assignment,
transition took less time,
throwing book.

Assistive Technology and Funding Proposal

McStraw 22

Appendix D
Goal: Maddie will
display school
appropriate
behaviors
encompassing the
entire school day,
in a variety of
settings in 3 out
of 5 days for four
consecutive
weeks.

Day 1:

Day 2:

Day 3:

Day 4:

Day 5:

III

II

IIII

II

IIIII

Maddie
became
frustrated
when she was
transition to
class and
during
activities. She
was able to
use the device
each time this
happened.

Maddie did not

understand
directions. She
used the device
to
communicate
her frustrations.
She also used
the device to
communicate
transitions.

Maddie used
the device all
day without
any hesitation

Maddie had to
be reminded to
use the device
once when she
became
frustrated, but
she did use it to
communicate
frustrations.

Today there
were many
transitions of
activities,
Maddie used
the device to
communicate
her frustrations.
She also used
the device to
tell her teachers
her frustrations
instead of
yelling at them.

-Overall, Maddie has shown progression in communicating her feelings and frustrations during transitions,
changes, and if she does not understand an activity or direction. Maddie also shows interest in using the device
each time she becomes frustrated. She only needs to be reminded 1-2 times during the day to use it. Maddie
will often verbalize what is frustrating her after she uses the iPad.