Transfer Forms
Cover Page:
The Cover Page is used to identify the student and transfer locations. It can be used as the front page to the Transfer Packet.
AT Listing:
The AT Listing is used to provide a complete list of assistive technology. It is intended to be used as a form to help you generate the list of AT currently being used. The AT Listing provides insufficient information to serve as the only transfer form.
AT Summaries 1, 2 and 3:
The AT Summary forms (1,2 and 3) are used to provide more information about individual devices. The three forms have been designed to provide space for naming the device, a description of item use, an IEP inclusion reference and an indication of whether or not the item will be transferred.
- AT Summaries READ ME File
- AT Summary 1 PDF File
- AT Summary 2 PDF File
- AT Summary 3 PDF File
- AT Summary 1 OmniForm File
- AT Summary 2 OmniForm File
- AT Summary 3 OmniForm File
Assistive Technology Device:
The Assistive Technology Device form is used to provide detailed information about any type of AT device. This form can be used if there is not a specific form for the particular type of device being transferred and you want to provide very detailed information about the device, device pieces and how it is used.
- Assistive Technology Device READ ME File
- Assistive Technology Device PDF File
- Assistive Technology Device OmniForm File
Computer or Word Processor:
The Computer or Word Processor form is used to provide detailed information about this device. It will guide the user to include important transfer information that is relevant to computers and word processors. This information may not be as clearly indicated if you choose to use one of the generic AT device forms such as Assistive Technology Device or AT Summary. This form can also be used for alternative keyboards, as many of the questions are relevant to this type of device, too.
- Computer or Word Processor READ ME File
- Computer or Word Processor PDF
- Computer or Word Processor OmniForm File
Communication Device:
The Communication Device form is used to provide transfer information about any type of communication device. There are device forms specific to the DynaVox and Prentke-Romich company devices and if you have one of those devices, you should use those forms instead of this more generic Communication Device form.
Dyna Vox Device:
The DynaVox Device form is used to transfer information specific to any of the DynaVox Systems devices.
Series 4 Devices:
PRC Device:
The Prentke-Romich (PRC) Device form is used to transfer information specific to any of the PRC devices.
FM System:
The FM System form is used to provide detailed information about the FM System used by the student.
Hearing Aid:
The Hearing Aids form is used to provide detailed information about right and/or left hearing aids used by the student.
Classroom Amplification:
The Classroom Amplification form is used to provide detailed information about the classroom amplification system used by the student.
- Classroom Amplification READ ME File
- Classroom Amplification PDF File
- Classroom Amplification OmniForm File
Cochlear Implant:
The Cochlear Implant form is used to provide detailed information about the Student's Cochlear implant system.
- Cochlear Implant System READ ME File
- Cochlear Implant System PDF File
- Cochlear Implant System OmniForm File
Software Summary:
The Software Summary form is used to provide a general list of software, to inform if the software is listed in the IEP and to convey the transfer status of the software. This is an at-a-glance form that will serve as a quick reference and as a checkoff as you complete the more detailed Individual Software form for the software listed on this Software Summary form.
Individual Software:
The Individual Software form is used to provide detailed information about individual software.
- Individual Software Summary READ ME File
- Individual Software Summary PDF File
- Individual Software Summary OmniForm File
Missing or Broken Equipment:
The Broken or Missing Equipment form is used to document any missing or broken devices or pieces of devices.
- Missing or Broken Equipment READ ME File
- Missing or Broken Equipment PDF File
- Missing or Broken Equipment OmniForm File
Discontinued Use Devices:
The Discontinued Use devices form provides important information about devices that have been used by the student and are no longer in use.
Student Worksheet:
The Student Worksheet form is intended to be completed by the student. This form can be used as a learning tool for students to think about their independent assistive technology use as well as a tool for conveying information to postsecondary environments.
Secondary Screening and Worksheet:
The Secondary Screening and Worksheet forms are to be used at minimum during 3-year re-evaluations throughout the junior high and high school years. The AT Screening for Secondary Students form is intended to serve simply as a screening tool for the IEP team to determine whether AT should be further addressed in the IEP. The WATI AT Assessment Checklist is intended to provide guidance as IEP teams begin to consider accommodations through assistive technology.
