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STUDENT INFORMATION
Student Name Grade Date of Birth
Mitch 4/28/08
School Date AT Plan Review Date
River Elementary June 22, 2019 June 22, 2019
EQUIPMENT
EQUIPMENT AND SOFTWARE TO BE USED STATUS (e.g., owned by school, will purchase, will borrow, etc…)
IMPLEMENTATION TEAM
NAME (List all individuals who will implement the AT with the student.) ROLE (e.g., administrator, teacher, family member, service provider, etc…)
Jonathan father
Lisa mother
Jenny Leclair 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.)
Software installed and set up Jenny 6/22
Software apps Osmo Numbers and Osmo Words Jenny 6/22
Manipulation Tiles dots and number tiles Jenny 6/22
Osmo Base and Mirrored attachment Jenny 6/22
Customize program for student Jenny 6/22
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)
Math addition facts to 10 Math Osmo Jenny Set up and Usage
Addition fluency Math Touch point Jenny Materials include manipulatives
Sounds and sign Reading Jenny Letter Tiles, Song
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)
Counting objects to add Math Lisa Will need to purchase equipment
Counting objects to subtract Math Lisa Will need to purchase equipment
Write and say his name Writing Lisa Repetition and Practice
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)