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MedLaunch Community Partner Form
Hi! Thanks so much for putting in the time to fill out this form. We hope to work with you and create something that could make a real difference!
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What is your name?
Your answer
What is an email address or phone number that we can reach you at?
Your answer
Given you are a persons with disability, is there a task that you would like made easier for you to do, or wish to make an activity possible that otherwise isn't? If so please explain below!
Your answer
Is there an existing device or assistive technology that you would like to see re-engineered to better suit your needs? If so please explain below!
Your answer
Would you be willing to work with students along the engineering process at your own leisure to make sure that the best device possible is delivered?
Yes
No
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Would you be willing to let us showcase any progress or final products for educational or presentational purposes?
Yes
No
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Would you be willing to meet in person to help us fully understand the issue so that we can better aid you?
Yes
No
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