Transfer Form
01 / Assistive Technology DetailsCurrent school to complete (school from which student is transferring)
Student name: Date of birth:
Current school: New school:
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or leaving school or no longer requires this assistive technology
If the assistive technology is no longer required or the student is leaving school please contact the district technology coordinator at your local Ministry of Education office.
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List of assistive technology provided by the Ministry of Education(You can request a list of current allocated equipment from your local Assistive Technology Coordinator). / Ministry of Education equipment ID number (if known)
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Other Equipment: for example Ministry of Health, ACC or other funded technologies such as a hoist, standing frame, slope board, communication devices etc (include serial numbers and source of technology if known):
Other equipment / Serial numbers as appropriate02 / Transfer Checklist
Current school to complete (school from which student is transferring)
To help with the transition for the student, please complete all sections that apply to this technology for the new school support team.
Transfer arrangements: Please outline the transfer arrangements if applicable (such as courier details, storage etc):
Yes N/A
This assistive technology is safe, and is in good working order
This assistive technology is being transferred with all documentation eg software information, manuals
If the device is being returned, all personal data (files and photos etc) have been removed from the device
The school have removed all administrative passwords, network/domain settings, and device from asset register
A copy of purchase invoice and supplier details has been given to the new school
A copy of most recent application for this technology has been given to the new school
Device Settings (when applicable):
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Serial numbers:
Account name and address used:
Passwords used:
Security questions & answers used:
Other useful details:
How was this device used?
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An example of HOW this technology was used by the student has been provided to the new school
This could be in the form of written instruction sheet
video
photographs
visual story
face-to-face training
Other useful details:
Ongoing support:
Contact for repairs/maintenance:
Contact for supplier:
Other useful contacts:
Person completing this form (section 1 & 2):
Name: Role:
Signed: Date:
03 / Management Plan - New school to completeNew school – to outline how the assistive technology will be cared for:
Ongoing maintenance: School IT support Supplier Support Not Applicable
Other (please specify):
Portable devices: Stored in locked cupboard Stored on teachers desk Not Applicable
Other (please specify):
Homework: Goes home regularly Goes home during holidays Not Applicable
Does not go home unless given special permission
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Other management:
04 / New school responsibilitiesAgree
This assistive technology has been received with all documentation (copy of purchase records, software information, manuals etc), and is in good working order.
Bring your own device policy:
I understand that if the student is entering into a digital class or a BYOD class where all students are required to have a device, the student is able to continue to use the allocated device(s). If the device requires upgrading to meet the class requirements, or any repairs or maintenance, they would not be eligible for additional Ministry of Education funding. The responsibility for this will be as per the schools policy on BYOD devices. Ministry of Education support continues to be available if the student requires any specialized assistive technology in addition to the required class device.
Agree
Please note the following processes and conditions must be followed. You accept that the school:
1. Will assume ownership of the assistive technology for the time that the student is enrolled in the school, including listing the technology on the school’s asset register, and maintaining a record of the serial numbers, asset numbers and warranty conditions.
2. Will ensure that the assistive technology is used for the intended purpose by the student it is allocated for.
3. Is responsible for the safekeeping of all assistive technology items such as original software, manuals and accessories etc. as documented in the management plan.
4. Is responsible for insuring the assistive technology and will contact the local Ministry of Education office if repair, maintenance or replacement of the item is needed (for more information on the Ministry of Education and school responsibilities in case of loss, damage or replacement, please see the Insurance and Repairs Fact Sheet).
5. Will support the implementation and ongoing use of the assistive technology within the school including the agreed training plan if applicable.
6. Will load appropriate school software and use appropriate school technology to support the student such as generic programs like Microsoft Office, virus software and access to school networks.
7. Will notify the local Ministry of Education office when the named student transfers to another institution or leaves school, and will transfer the assistive technology to the new school (with the student) or return it to the Ministry of Education.
8. Agrees that the scanned version of this document can act as the record copy for this transfer.
Principal name: School:
Signed (Principal): Date:
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