Teacher Questionnaire

Please rank in order your top four areas of concern for your student.

Reading Skills

Mechanics of Writing

Writing Composition

Rows	Rating	Describe
Prewriting/ Organizing Ideas
Spelling
Editing/ Revising
Vocabulary
Capitalization, punctuation, grammar
Other

Mathematics

What supports/ accommodations are already in place to help the student overcome identified challenges?

The student can...

Rows	Idependently	With Assistance	N/A
Navigate a computer
Search for resources on the internet
Use spell check and grammar check
Open desired applications/ assignments
Save files and folders
Compose written materials on the computer
Easily switch back and forth between assignments and pages

Do the students have 1:1 devices?
1:1 Device

Other
Keyboard
Uses built-in keyboard
Uses external keyboard
Uses speech-to-text:   Brand
Uses alternative keyboardBrand
Mouse
Uses standard trackpad
Uses alternative keyboard:
Uses alternative mouse:   Brand
Uses switch access:   Brand
Typing skills (check all that apply)
Can they take their device home?
What types of devices are available in the classroom for the students to use? Check all that apply

Other
Typing Program
In your classroom, about what % of the student's time is spent using his/her device?
To the best of your knowledge, about what % of the student's entire school day is spent using his/her device?
To the best of your knowledge, about what % of the student's entire school day is spent using his/her device?
Please include any other important information about the student:
Should be Empty:

Assistive Technology Teacher Questionnaire