Technical Assistance Request Form

Technical Assistance Request Form
The Indiana Department of Education Office of Special Education supports Local Education Agencies in a variety of areas free of charge. When completing this form, please include as much detail as possible regarding the type and level of support needed. A member of the IDOE team or an affiliate will reach out to the point of contact with next steps based on the details provided. Visit IDOE’s Office of Special Education webpage for additional information.
Name*

First NameLast Name
Title/Position*
Phone Number*
Phone extension (if applicable)
Email Address*

Confirmation Emailexample@example.com
District/Organization*
If you selected 'Other' for District/Organization above, please specify.
School Name (if applicable)*
For which student population are you requesting assistance? (mark all that apply)*

English learnersStudents with disabilitiesOther
Please select the option that best fits the anticipated need. If unsure, select Technical Assistance*

Workshop/TrainingTechnical AssistanceOperational Support (Assistive Tech/AEM/IT Support for IIEP/etc.)Complaint Investigation Corrective Action

Workshop/Training
The Office of Special Education collects and curates content for ready-to-go professional development. This includes but is not limited to Universal TA, Moodle Courses, IEP-TA Center Trainings, ATLAS Assistive technology support, and Individualized PD.
Desired Subject(s) of Training/Workshop
Describe Anticipated Audience (who will attend the training? exs: paraprofessionals, special education teachers, administrators)
Frequency/Duration (Preferred length of training or workshop?)
Ideal dates for training/workshop to take place (Provide a variety of options if possible).

Technical Assistance
Technical Assistance Defined

Technical assistance, also known as “TA'' and commonly referred to as consulting, is the process of providing targeted support to an organization with a development need or problem. It is an effective method for building the capacity of an organization.

TA involves communication between a specialist or consultant and the organization. The specialist should be aware of the organizational culture and any specific circumstances related to the development need. TA is also typically delivered over an extended period of time.

In order for technical assistance to be effective, the specialist or consultant should adhere to a set of core principles. Effective TA should be:
- Collaborative – Work jointly with the organization’s staff to identify underlying needs.
- Systematic – Use an orderly approach.
- Targeted – Determine where technical assistance will have the greatest impact.
- Adaptive – Be flexible.
- Customized – Respond to the unique needs of the organization.
- Results-driven – Identify measures that indicate improvement.
The structure of how technical assistance is delivered varies. It can be one-on-one consultation or small group facilitation. TA can be provided in person or through online methods such as Web-conferencing.
Description of Need (please be as specific as possible) Do not list any student specific identifiable information such as a name, STN, social security number, or otherwise.

0/30000
Have you previously engaged in TA? If so, with whom?

Operational Support
OSE partners with ATLAS to provide assistive technology support that aids individuals and improves outcomes for all learners in the LEA as a whole. The following questions will determine the correct path for assistive technology, accessible educational materials (AEM), and/or other help desk related services.
Is desired support for a new assistive device? Please explain.
Is desired support for an assistive device already utilized by student/LEA? Please explain.
Is desired support for Accessible Educational Materials (AEM)? Please explain.
Other Help Desk or technology related questions? Please explain.

Complaint Investigation Corrective Action
Please complete the following fields to indicate a request for support based on a complaint.
Complaint Number
Complaint Investigator Name

Zoretta Ward-HollowayReva WeissBrooke RussellChristina Pace
Please upload a copy of the Complaint Investigation Report.

Browse Files

Cancelof

Impact
Please provide the following additional information for data tracking purposes.
Anticipated number of staff members attending this experience*
Anticipated number of students impacted by the experience*
Grades impacted by this experience*

Elementary (K-5)Middle (6-8)High (9-12)
Should be Empty:

Technical Assistance Request Form

Workshop/Training

Technical Assistance

Operational Support

Complaint Investigation Corrective Action

Impact