Assistive Technology Return Form

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Assistive Technology Return Form

Please fill out the survey below if you currently have a Special Education Assistive Technology device that you would like to return. After completing the form, a member of the Assistive Technology Team will contact you to arrange retrieval of the device.

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* Indicates required question

Last Name *

Your answer

First Name *

Your answer

School of Attendance *

Your answer

Case Manager *

Your answer

Reason for returning *

Student is a graduating Senior

Student is not returning for the 20/21 school year

Student does not need the device for the summer/does not want to responsibility

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