Project KITE Application: Teacher/Service Provider

"Thank you Project KITE staff!! The presentations and trainings were well-organized and well-presented with practical information for (the) learning needs of a diversity of students."

- Speech-Language Pathologist

"Excellent program! This had a great impact on the child's life. All the ideas were very helpful. Especially helpful were the ideas for IEPs, goals, and objectives."" - Early Childhood Special Education Teacher

- Elementary Special Education Teacher

"It (Project KITE) was excellent. I always looked forward to the sessions to learn more new ideas. Thank you!"

- Occupational Therapist

KITE participants looking at communication boards and books at a workshop

Teacher/Service Provider Participation Form

Project KITE requires that each of the teams participating in the training program consist of the following:

a teacher of a class in which children with disabilities are included,
parents or guardians of children with disabilities included in the class, and
a service provider or paraprofessional who works with the classroom.

Name:
Date:
School/facility name:
Title:
Student's Name:
Grade/Year in School:

Please describe the child's disability:

Please describe the child's strengths:

Tell us about your computer skills.
- How familiar are you with computers?
  - Not at all
  - Somewhat
  - Comfortable
- What type of computer(s) have you used?
- What software programs have you used?
- What type of computer do you have access to:
  - at work?
  - at home?
Are you familiar with assistive technology (AT) devices or software?
- Not at all
- Somewhat
- Comfortable
What assistive technology devices or software have you used with your child?

Please describe AT devices or software that you wish to learn more about in Project KITE trainings:
Please tell us about the children with whom you work.

How many children with disabilities do you work with on a weekly basis and what are their disabilities?
- What are the ages of the children you work with?
  - 0-1
  - 2-3
  - 4-6
  - 6-8
  - Other
- Do you work with children from the following cultural backgrounds?
  - African-American
  - Hispanic
  - Hmong
  - Native American
  - Asian American
  - Lao
  - Caucasian
  - Other, please specify:
- Which income groups represent the children you work with?
  - lower
  - lower-middle
  - Middle
  - middle-high
  - high
- In which geographical areas do the children you work with live?
  - Inner-city
  - Suburb
  - Reservation
  - Rural
  - City
  - Other, please specify:
Would you be a potential resource person for others?
- Professionals How many?
- Parents How many?
- Another KITE Team?
Please write a few lines about why you wish to attend this training and the skills you hope to acquire through Project KITE.

I am interested in participating in Project KITE and will agree to attend the training sessions and to work with the team for the benefit of my child.

Address:
Phone (h):
Phone (w):
E-mail (h):
E-mail (w):

Visit PACER's other sites: National Parent Center Network (ALLIANCE) | Kids Against Bullying | Project C³ | FAPE Project | Minnesota SEACs

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Teacher/Service Provider Participation Form