1. CHILD-SPECIFIC EQUIPMENT RECOMMENDATION
      1. DATE:     
      2. IEP TEAM MEMBERS' SIGNATURES
      3. SS RECOMMENDATION:          
    EVERETT PUBLIC SCHOOLS
    3900 Broadway (425) 385-5250
    SPECIAL SERVICES
    EVERETT, WASHINGTON 98201


     





    CHILD-SPECIFIC EQUIPMENT RECOMMENDATION


     





    DATE:        


     
    STUDENT DOB: CA:
      
    SCHOOL: TEACHER/GRADE:
    EQUIPMENT/TECHNOLOGY RECOMMENDED:  
      
      
      
      


     
    PRODUCT INFORMATION/VENDOR/PRICE LIST SHIPPING CHARGES:   
     
     
     
     
     


     
    RATIONALE:   
     
     
     


     





    IEP TEAM MEMBERS' SIGNATURES

     
       
    Teacher   INTERVENTIONIST
       
       
    Teacher   NURSE
                                 
       
    SLP   PSYCHOLOGIST
       
       
    OT/PT   PRINCIPAL





    SS RECOMMENDATION:                  

     

                             

     

     

                       

    DIRECTOR'S SIGNATURE          DATE

     

    · PLEASE FORWARD THIS FORM TO: PATTI MCCLINCHY, SPECIAL SERVICES, CRC

     

     

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