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Referral Information

May 05, 2015

Please contact kwiebe@bcsbc.org for referral questions or to email the completed referral paperwork.  The documents can be downloaded below:

Classroom assessments:  

This assessment is for multiple students in a classroom, classroom adaptations, or students with general A.T. needs (software the COOP owns, low-tech solutions, etc.).

Referral Form for teacher

Seating & Mobility Form

Communication Form

Computer Access Form

Writing: Motor Form

Writing: Composition Form

Reading Form

Math Form

Rec/Leisure Form





Individual assessments:  

This in-depth assessment is for an individual student who presents unique and multiple needs.

Parent consent form for parent(s)

Referral Form for teacher

Parent Intake Form for parent(s)

Choose correct form from above as appropriate (motor, vision, etc.)


Referral paperwork can be sent to:

Andover High School
c/o Assistive Tech Kristin Wiebe (Stadium)
1744 North Andover Road
Andover, KS 67002
Fax:  (316) 733-3681

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