Phone: (No Dashes) Email:

Training Set Up (Select One):

Instructional/Demonstration Only (presentation with handouts/instructor demos)
Instructional/Hands-On (presentation with handouts, demos, and participant practice)
Consultation Only (discussions of specific cases, assistance with A.T. Assessments, etc.)

In the space provided, please describe the type of Assistive Technology training(s) and/or in-servicing needed for your district. In your short narrative, please give an estimate of the number of participants, the focus area(s), and the target audience. If this is a consultation request, please provide background information about the student(s) or use the student observation form, also found on our website.

Person Making Request:

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