EDUCATIONAL VISION SERVICES
Image of BrailleWriters and BookPorts on a classroom desk

Forms & Documents

Click on the item you need below. This will download the form/document to your computer and you can then print it out or save it. Click Link for Orientation and Mobility forms and documents.

EVS Assistive Technology Referral Form - Please make sure you fill the form in completely and include the student's IEP, Functional Vision Assessment and E12S eye report. Please note - an incomplete referral will be returned, causing delay in scheduling the Assitive Technology Evaluation.

Provider Schedule - Word Version - Please note The Provider Schedule requires 8 1/2 x 14 legal size paper

Monthly Attendance Record

Paraprofessional Monthly Attendance Record

Supply Request Form

Book Order Form

APH Quota Ordering Form

Letter for Principal to Request Book for Brailling or Enlarging

E-12S Eye Report Form - You will need 8 1/2 x 14 legal size paper to print the eye report form

Eye Report Request Letter

Legally Blind Form

Gift of Sight - Here are the instructions for Lenscrafter's Gift of Sight program as well as the letter you will need to complete for the student to bring with them to the appointment.

Instructions for the Gift of Sight Program

LensCrafters Letter

Zipfile containing Translations of the Instructions for the Gift of Sight Program into nine languages

Zipfile containing Translations of the LensCrafters Letter into nine languages

Functional Vision Assessment Form

Mini Lesson Model

Keyboarding - Memo explaining EVS Keyboarding Curriculum - as part of the EVS keyboarding curriculum, EVS has a skills chart available for download. The EVS Skills Assessment form is available as both Microsoft Word and PDF formats.

Per Session Timesheet

Orientation & Mobility Evaluation Request Form

Orientation & Mobility Screening Form

Parent/Teacher Conference Attendance Report

Offsite Equipment Form - Staff

Offsite Equipment Form - Student

Dispostion of Obsolete Equipment Form - Print out this form, do not submit it online

EVS Reimbursement Form

Tax Exempt Form

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