LADSE                   LaGrange Area Department of Education

Assistive Technology Unit

EDUCATIONAL TEAM REQUEST FOR AT CONSULTATION

REGARDING PREVIOUSLY SERVICED STUDENTS

One Time Troubleshooting (OTT) Request Form

PLEASE NOTE:  With this form, you are requesting a one time troubleshooting or training session with an assistive technology consultant.  If any further assistance is required, you will need to submit additional requests.

    Student:     District:   

    School/Educational Team:       

    Contact Person:    

            Phone:   

            Email:      

            Best Time to Call:   

    Specific need to be addressed:   

    Prior AT Consultant, if known:        

                                                                                                                                        (Please click only once)

For Office Use Only

                Date Received:                                                 

                Phone Contact:                                                   

                Consultation Date: