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Physical Disabilities Program Motor Characteristics Checklist

About this Form

Form number: 336-24

Audience:  School Staff

Last revised: September 2014

INSTRUCTIONS: This form is to be used by teachers or other observers when they believe a student should be referred to the IEP Committee for discussion of motor/physical development needs. If the IEP Committee decides to refer the student for occupational therapy/physical therapy assessment, include completed form in the referral packet. Check the boxes that describe the observed motor characteristics of the student.

Adobe PDF Physical Disabilities Program Motor Characteristics Checklist81 KEnglish

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