To: (Classroom Teacher)

From: (Physical/Health Disabilities Teacher)

Date:

Re: Please note the attached confidential information about a student who is in your class this (semester/year). I will be consulting with the educational staff who work with this student, providing information and resources as they relate to his/her disability.

As a Physical/Health Disabilities teacher, I work with students who meet the special education criteria in the categorical area of Physically Impaired.

(EDIT NOTE: OHD and TBI may also be added here.)

The following lists some of the ways I may be of assistance to you and/or the student:

  • Provide consultation to staff and students regarding the use of technology and specialized equipment/materials as they relate to meeting instructional needs or environmental access.
  • Evaluate the efficacy of assistive technology for students who have motoric challenges andare unable to complete work in a timely manner
  • Provide information about the student’s medical diagnosis and implications for learning
  • Provide information about educational, community, and online resources that may assist the student, the educational team, and his/her family
  • Help the student learn how to advocate for his/her needs
  • Assist the team in identifying appropriateaccommodations and/or modifications to the curriculum, class assignments, and physical environment
  • Observe the student in the classroom to assess the student’s current needs and offer suggestions and strategies to help the student be successful and independent in the school environment
  • Assist the classroom teacher in providing modified or alternate methods of task completion; and

setting realistic expectations for the student

  • provide an inservice to the class to explain the student’s disability
  • Collaborate with other team members to assist with the evaluation process, writing the IEP, and providing ongoing monitoring and progress review

Please feel free to contact me if you have any questions about this student, or would like to set up a meeting to discuss any current issues.

I can be reached at:

Email Address:

Phone:

Thank you for your help and support in making this a successful year for this student.

NOTE: This form was developed to provide a general template for P/HD teachers to use and/or adapt to meet their individual needs.

Revised 9/2011