Student Services Staff Assistive Technology Request I-Form

Wauwatosa Staff Member,

We are happy to assist you with materials to use with your students.

Please fill out the first four items on the I-form below to request assistive technology materials.

Once the Student Services staff receives the I-form, they will process it as soon as possible.

Thank you

Student Services Assistive Technology Check Out Form:

*

Staff Member:
*

School:
*

Phone Number and Email:
*

Type  of Assistive Technology Request (please include the specific item names(s)):

For Student Services Office Use Only:

Items Checked Out:

Date Checked Out:

Dated Returned:

Returned in good condition or needs to be replaced:

Type in the text that you see above:

  

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The Wauwatosa School District does not discriminate on the basis of a person's color, sex, race, religion, national origin, ancestry, creed, pregnancy, marital status, sexual orientation, or physical, mental, emotional or learning disability.
Wauwatosa School District · 12121 West North Avenue · Wauwatosa, WI 53226 · 414-773-1000