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STUDENT INFORMATION
Student Name Grade Date of Birth
Shane Smith 8th 5.21.2001
EQUIPMENT
EQUIPMENT AND SOFTWARE TO BE USED STATUS (e.g., owned by school, will purchase, will borrow, etc…)
EYE TRIBE School owned
IMPLEMENTATION TEAM
NAME (List all individuals who will implement the AT with the student.) ROLE (e.g., administrator, teacher, family member, service provider, etc…)
Special Education Teacher
Speech Pathologist
Vision Teacher
EQUIPMENT TASKS
TASK (e.g., order/procure AT, load software, adapt/customize devices/software, set up PERSON RESPONSIBLE DATE DUE
at home/school, maintain/repair, etc.)
Technology installed on computer(s) being utilized and calibrated by teacher each time Special Education Teacher N/A owned by school
TRAINING
TRAINING NEED TRAINEES TRAINER DATES & TIMES FOLLOW UP / ALONG PLAN
CLASSROOM IMPLEMENTATION
IEP GOAL CURRICULUM/DOMAIN (e.g., PERSON(S) RESPONSIBLE AT NEEDED TO ACCOMPLISH GOAL (List specific
math, science, PE, art, etc…) AT and customized settings if appropriate)
Appropriately respond to questions Academic Content Special Education Teacher EYE TRIBE
Speech Pathologist
Access games/activities on the computer Leisure/Recreational Special Education Teacher EYE TRIBE
Speech Pathologist
Communicate Wants/Needs Communication Special Education Teacher EYE TRIBE
Speech Pathologist
HOME IMPLEMENTATION
IEP GOAL CURRICULUM/DOMAIN (e.g., PERSON(S) RESPONSIBLE AT NEEDED TO ACCOMPLISH GOAL (List specific
math, science, PE, art, etc…) AT and customized settings if appropriate)
N/A
MONITORING/EVALUATION
GOAL INSTRUCTIONAL STRATEGY RECORDING SYSTEM & FREQUENCY PERSONS RESPONSIBLE FOR
(How will you teach student to use equipment (e.g., task analysis recording system; score + or - on IMPLEMENTATION / DATA COLLECTION
and/or how to achieve goals.) data recording sheet)
The student will answer 3 out of 5 questions Trial and Error Data Sheets using + (correct/successful) Special Education Teacher
using Eye Tribe correctly and – (incorrect/unsuccessful) for each Speech Pathologist
attempt
The student will access/use games software for Trial and Error Data Sheets using + (correct/successful) Special Education Teacher
10 minutes and – (incorrect/unsuccessful) for each Speech Pathologist
attempt. Length (time) of each attempt
The student will respond appropriately when Trial and Error Data Sheets using + (correct/successful) Special Education Teacher
asked about wants/needs 4 out of 5 and – (incorrect/unsuccessful) for each Speech Pathologist
opportunities attempt