Form 1: General Student Information (Appendix G)
This form allows tracking of the Learning Media Assessment process and collates information on additional disabilities and the results of Ophthalmologic, Clinical Low Vision, and Functional Vision evaluations. In addition, it includes a summary of the Learning Media Assessment results.
Form 1 looks at the uses of sensory channels. It collates information of additional disabilities and the information from the ophthalmologist (clinical vision). The form notes prior Functional Learning Media Assessment results or what the TVI may have done as a functional vision evaluation. It also includes a summary of prior learning media assessment results. This form is a nice way to get started because it gives you a record of what the child's going to be doing over time.
Form 1: General Student Information (Appendix G: Blank Assessment Forms)
*Scaled-down sample versions of Appendix G (Blank Assessment Forms) can be viewed in this education module. To use these forms, please acquire by purchasing Learning Media Assessment: A Resource Guide for Teachers.