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Utah Augmentative Alternative Assistive Communication Technology Team REFERRAL FORM STUDENT AGE/DOB PHONE ADDRESS PARENT/GUARDIAN DATE SCHOOL DISTRICT/TEAM None Referral Source/Contact Person School Address School Phone Diagnosis Approximate Cognitive Functioning Level Program Placement Reason for Referral What do you hope to gain from this referral/assessment HEALTH CONCERNS Hearing status Visual functioning Seizures frequency duration etc. Medications Overall health status COMMUNICATION CONCERNS List student s current means of communication and/or attempts to communicate and/or make needs known i.e. signs gestures communication aide symbol systems vocalizations. How successful are communicative attempts Do you believe the student gets frustrated Are there persons within this environment with whom the child may communicate effectively Please describe. Does the student indicate yes and no If so please describe. Do you believe the student understands more than he/she is able to express ....

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The term “assistive technology device” means any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of a child with a disability.

The Utah Center for Assistive Technology (UCAT) is a statewide resource offering information and technical services to help people with disabilities acquire and use assistive technology devices. UCAT offers free evaluations to anyone within the state of Utah.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232