Making a Referral for an Assistive Technology Services
The Kornreich Technology Center provides assistive technology (AT) evaluations to individuals of all ages with a variety of disabling conditions. Evaluations are conducted by certified professionals in speech/language pathology and/or occupational therapy who have specialized in assistive technology. See Why Do I Need an Assistive Technology Evaluation? for more information on the purposes of an evaluation. If support in the use of assistive technology is required, the KTC also provides training, technical support, and so on.
Most often a rehabilitation or educational agency or professional initiates a referral, but an individual or family member may also make a referral.
Materials to be Submitted with a Referral
When submitting a referral to the Kornreich Technology Center, please be sure that the referral packet contains the following forms and reports:
If you prefer to send a letter instead of using the Kornreich Center form, please make sure that the letter contains the same information as the form, including the applicable hourly rate(s) for the services requested. (Services do not begin until this form is received.)
To be completed by the consumer, or by a parent or other person familiar with the consumer's needs for assistive technology. This form gives us the consumer's perspective on the purpose of the evaluation, barriers to achieving goals, and environment in which the technology will be used.
To be completed by the person at the agency initiating the referral who is most familiar with the consumer’s need for assistive technology, such as a teacher, therapist, or personal attendant. Input from more than one professional is welcomed, either on the same or separate forms. If information requested is specifically addressed in one of the background reports (see below), write "see [OT/PT, etc.] report, enclosed" in the appropriate places on this form.
Specifying to whom the evaluation report should be submitted, and authorizing the Kornreich Center to release information to those individuals or agencies. (Services do not begin until this form is received.)
This 15-page document contains instructions, forms (including the forms mentioned above) and a detailed list of fees.
View/Print this form
The more information we have about the consumer's current abilities, environment (human and non-human), goals, and past experiences relevant to technology, the better we will be able to plan and conduct the evaluation. Please submit the most current reports, if they exist for this consumer:
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