YES STAFF RELEVANT OBSERVATIONS FOR 2011-2012 FINALISTS WITH

VISUAL IMPAIRMENTS


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To be completed by K-L YES Consortium Staff


Student Name: _____________________________________

YES Staff Name: _____________________________________


Do you believe this student is disabled?
___Yes ___No ___Not sure (please explain)





1. Please describe and explain your observations about the students disability,
interests, independent living skills, strengths, and other relevant matters.



















2. Based on your observations and conversations with the student and parents, what
assistance, adaptations, equipment, orientation or training will the student likely
need to be independent and successful in the home, community and/or school?
















YES STAFF RELEVANT OBSERVATIONS FOR 2011-2012 FINALISTS WITH
VISUAL IMPAIRMENTS


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3. What questions, concerns, expectations or ideas do you have or have been raised
by the participant and/or their parents about international travel and the exchange
year?




















4. Do you believe the student can function in a U.S. public high school that is not a
school for the blind? Please thoroughly explain your answer. If the student or NP
has concerns about a placement in a school for the blind, please summarize the
reasons why. Note: The YES program cannot guarantee which type of school the
student will attend in the U.S.



























YES STAFF RELEVANT OBSERVATIONS FOR 2011-2012 FINALISTS WITH
VISUAL IMPAIRMENTS


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5. Please check yes or no to the following statements. If you answer no to a
question with an asterisk (*), please explain your answer in question 2, above. Dont
forget to include any other relevant comments in that section.

Yes No
Student is completely blind
Student is partially blind
Student has vision in one eye
Student can write with a pencil
Student can type with a typewriter
Student can read a blackboard
Student can read large print
Student can see but it is blurry
Student can prepare meals*
Student can do house work*
Student can dress and undress by himself*
Student attends a special school for the blind


If the student uses Braille:
1. Please describe what languages the student knows in Braille and to what extent:







2. Please list what types of equipment the student uses and/or absolutely needs:










YES STAFF RELEVANT OBSERVATIONS FOR 2011-2012 FINALISTS WITH
VISUAL IMPAIRMENTS


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If the student is partially blind:
1. Please describe what classroom objects the student can see. Clarify at which point
things become blurry versus clear:












2. Please explain in detail if the student can see colors (if only some colors, please list
which) and/or shades of colors:












3. If the student will be bringing a computer or typewriter with him/her to the US, please
describe the device in as much detail as possible and any relevant features (i.e. voice
recognition software or other).