Assistive Technology Services
2551 Vegas Dr.
Las Vegas, NV 89106
(702) 855-8440
CCSD Website
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Forms
Level II – Access through Equipment Loan (formerly Region Kit Check Out):
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| Equipment Loan Request: Use this form for a 30 day trial of “Light tech” devices intended to provide access to those educationally-based needs that are less complex and less costly. |
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Level III – Access through Referrals:
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| Initial Referral Forms: Use this form for students who have never had assistive technology when submitting a referral through an IEP request. |
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PDF |
| Re-Referral Form: Use this form for students who have had previous assistive technology assessment when submitting a referral through an IEP request. |
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| Out of District Referral Form: Use this form for students entering CCSD with out of district IEPs. This referral is only necessary if site based Assistive Technology will not meet the student’s needs. |
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Other Forms: |
| Sign Out Sheet: Use this form for transfer of assistive technology issued specifically to a student from one school to another within CCSD. Please contact your Area Lead* and return completed form to Assistive Technology Services #197. Note: Site based equipment should NOT be removed from a school campus. |
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| Parent Agreement Form for Loan of Assistive Technology Equipment: Use this form when equipment is utilized between home and school – please contact your Area Lead* prior to this occurring – specific guidelines apply. |
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| Parent Agreement Form for Loan of Assistive Technology Equipment (Spanish): Use this form when equipment is utilized between home and school – please contact your Area Lead* prior to this occurring – specific guidelines apply. |
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PDF |
Click here for list of Assistive Technology Area Lead Contacts.
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