Iowa Deafblind Project Technical Assistance Request Form

Deafblind Technical Assistance Team (DTAT)

Technical Assistance is available by request to families, service providers, schools, or districts. Technical assistance may be provided on-site or it may involve distance technology. It may also involve specific training opportunities to LEA and/or AEA staff. Through the provision of technical assistance, the goal of Iowa’s Deafblind Services Project is to increase educational achievement by supporting teams requesting assistance with assessment, designing instructional programs, and regular, ongoing implementation of program recommendations.

The Deafblind Technical Assistance team (DTAT) focuses on educational strategies that are meaningful to children who are Deafblind, the people who serve them, and their families.

Please complete the information below to request Technical Assistance (TA).

Question Title

* Name of student

Question Title

* Information for person making the request

Name

Role

Email Address

AEA

School Building

District

Question Title

* School building's administrator contact information

Name

Contact telephone number

Question Title

* Is the building administrator aware of the technical assistance request?
*The Iowa Deafblind Project staff will be reaching out to the administrator once the TA request is received.

Yes

Question Title

* Parent or guardian information.

Parent or guardian name

Contact information

Question Title

* Is parent (guardian) aware of of the TA request?
*The Iowa Deafblind Project Family Engagement Coordinator will be reaching out to the parent (guardian) once the TA request is received.

Yes, parent (guardian) is aware of the request

No, parent (guardian) is not aware of the request.

The team would like help explaining the TA request to parent (guardian).

Question Title

* Briefly summarize why the team wants to engage in technical assistance.

Question Title

* Is there any other information you would like to share?

Question Title

* I acknowledge that following the submission of this form, staff from Iowa Deafblind Project will be reaching out to gather additional information and to schedule a TA planning meeting with the team.

Yes, I acknowledge that the team will reach out to me

Question Title

* I acknowledge that Iowa Deafblind Project staff will be using readiness for TA factors in planning for TA for my team. Readiness factors can be found here: Link to TA Readiness Factors

Yes, I am aware that readiness factors will be used.

Question Title

* I acknowledge that Iowa Deafblind Project staff will be using a needs assessment, such as the TSBVI quality indicators (Link to Needs Assessment), to help identify the needs of my student’s team.

Yes, I am aware that a needs assessment will be used.

Iowa Deafblind Project Technical Assistance Request Form

Deafblind Technical Assistance Team (DTAT)

Question Title

* Name of student

Question Title

* Information for person making the request

Question Title

* School building's administrator contact information

Question Title

* Is the building administrator aware of the technical assistance request? *The Iowa Deafblind Project staff will be reaching out to the administrator once the TA request is received.

Question Title

* Parent or guardian information.

Question Title

* Is parent (guardian) aware of of the TA request?*The Iowa Deafblind Project Family Engagement Coordinator will be reaching out to the parent (guardian) once the TA request is received.

Question Title

* Briefly summarize why the team wants to engage in technical assistance.

Question Title

* Is there any other information you would like to share?

Question Title

* I acknowledge that following the submission of this form, staff from Iowa Deafblind Project will be reaching out to gather additional information and to schedule a TA planning meeting with the team.

Question Title

* I acknowledge that Iowa Deafblind Project staff will be using readiness for TA factors in planning for TA for my team. Readiness factors can be found here: Link to TA Readiness Factors

Question Title

* I acknowledge that Iowa Deafblind Project staff will be using a needs assessment, such as the TSBVI quality indicators (Link to Needs Assessment), to help identify the needs of my student’s team.

* Is the building administrator aware of the technical assistance request?
*The Iowa Deafblind Project staff will be reaching out to the administrator once the TA request is received.

* Is parent (guardian) aware of of the TA request?
*The Iowa Deafblind Project Family Engagement Coordinator will be reaching out to the parent (guardian) once the TA request is received.