CABELL COUNTY PUBLIC SCHOOLS EQUIPMENT RECOMMENDATION FORM Student NameDate of Birth Month Day Year SchoolMonitoring TeacherDescription of equipment being requestedInclude specific item number if possible.Equipment specifications if applicableSize, weight, etc.Upload photos of specific equipment, if applicableMax. file size: 256 MB. Recommended supplier/companyRecommended vendors MUST take PO ordersEquipment currently being utilized with the studentStatement of justification for requested equipmentDoes equipment requisition require an IEP Targeted Review or a Phone Amendment?Date of teacher/therapist consultation Month Day Year Date of parent/guardian consultation Month Day Year Referring therapist's name and titleTherapist's SignatureYour NameYour NameYour NameYour NameTherapist's SignatureYour NameYour NameYour NameYour NameDate submitted Month Day Year
