Request for Technical Assistance

Request for Technical Assistance
Student Name

First NameLast Name
Gender of student
Date of Birth

MonthDayYear
Date
Is the student on the KS Deafblind registry through the KS Deaf-Blind Project?
School District or Program
Name of person making TA Request

First NameLast Name
Email
example@example.com
Please list all of the members of the tea that will be in attendance along with their emails and title/position.
Areas of Need

Other
Briefly describe the type of assistance you are requesting. Include any additional information that may be helpful:
Briefly describe the student (diagnoses, type/degree of hearing and vision loss, current accomodations, etc.)
What days and times typically work best for a meeting with your team? (e.g. Friday's at 9:00AM)?
Was a parental consent form/ROI already submitted for this student?
If you answered No to the previous question, please ensure the parents/guardians sign this consent form before submitting this request form. Once signed, you can either attach the form here or email it to Katie Paul at kpaul@kansasblind.gov.
Should be Empty: