EVS Forms

Contact David Cohen  for more information.

Educational Vision Services Forms

Title Size
Paraprofessional Monthly Time Sheet 793kb
Provider Schedule 112kb
Monthly Attendance Record 76kb
Supply Request Form 28kb
E-12S Eye Report Form 40kb
Book Order Form 40kb
APH Quota Ordering Form 32kb
Letter for Principal to request Book for Brailling or Enlarging 48kb
Functional Vision Assessment Form 72kb
EVS Keyboarding Skills Chart 64kb
EVS Keyboarding Skills Assessment 64kb
O&M Screening Form 36kb
EVS Assistive Technology Evaluation Instructions 380kb
EVS Assistive Technology Referral Form 2.5mb
Legally Blind Form 144kb
Eye Report Request Letter 44kb
Parent/Teacher Conference Attendance Report 24kb
Offsite Equipment Form – Staff 432kb
Offsite Equipment Form - Student 308kb
EVS Reimbursment Form 16kb
EVS Database Shell - Fall 2013 712KB

Orientation and Mobility Services Forms

Title Size
Instruction Consent Form 88K
Evaluation Consent Form 98K
Orientation and Mobility Evaluation Request 22K
O&M Screening Form 36K
Orientation & Mobility Evaluation Report 78K
Special Progress Report 27K
Indoor Dynamic Functional Vision Checklist 98K
Outdoor Dynamic Functional Vision Assessment 74K
Log Book Cover Page 64K
Safety Cards 44K
Log of Student Lessons 64K
Independent Travel Agreement 95K
Indoor Travel Clearance Procedures Memo 62K
Indoor Independent Travel Checklist 28K
Parent Consent for Indoor Independent Travel Form 59K
Parent Consent for Continuation of Indoor Independent Travel 60K
Requirements for Route Travel Clearance 84K
Director's Memo Independent Community Travel 58K
Outdoor Independent Travel Checklist 68K
Parent Consent for Outdoor Independent Travel Form 65K
Independent Outdoor Travel Student Agreement 61K
EVS Referral to Travel Training 76K
Fire Drills and Emergency Evacuation Procedures 35K
No Clearance Sample Parent Letter 92K
No Clearance Sample Parent Letter- Spanish 660K
Parent Consent for Instruction Between Home and School 89K
Parent Consent for Exchange of Informationwith Outside Providers 54K
EVS Paraprofessional Roles and Responsibilities 37K
Paraprofessionalism 86K
EVS Guide for Teaching Subway Travel 66K
Mobility Jeopardy 84K


Related Services Home
Adaptive Equipment
Health Services
Hearing Education Services
Interpreting Services
Occupational Therapy (OT) 
Office of Related and Contractual Services (ORCS)
Orientation and Mobility Services
Physical Therapy (PT)
Speech/Language Therapy
Educational Vision Services

District 75  |  400 First Avenue, New York, NY 10010  |  (212) 802-1500  |  Contact