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What are your assistive technology (AT) related needs?
Is there an AT device you want to try but it is not available in our loan library? Complete this form and let us know!
We at NMTAP may not be able to purchase everything suggested but when funding is available we can use this list to purchase AT needs for the community.
All information provided in this form will be kept confidential.
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What assistive technology device would you like to try or see added to our loan library?
*
Your answer
Are you... (select all that apply)
*
an individual with a disability
a parent, family member, or authorized representative of someone with a disability
a healthcare, rehabilitation, or therapy professional (eg: OT, Case-manager, care coordinator)
a representative of education (eg: teacher, EA, school counselor, adult educator, professors)
a representative of employment (eg: VR counselor, job coach, HR rep, DWS)
a representative of community living (eg: staff of disability providers, CIL, senior programs)
Other:
Required
Would you like a staff member from NMTAP to contact you regarding your AT request?
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Yes
No
If yes, please provide your name and phone number or email address that is best to reach you
Your answer
If you would like to be added to our email distribution list please provide your name and email address below:
Your answer
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