Loan Closet Inquiry Form
Thank you for inquiring about our free assistive technology (AT) loan equipment. The Community Vision AT Loan Closet is made possible by the Christopher & Dana Reeve Foundation and the Sidney & Lillian Zetosch Fund of the Oregon Community Foundation.
Loans are typically provided on a 2-week trial basis with in-person pick-up and drop-off at the AT Lab during our free Open Lab Hours (Thursdays 12:00-5:00pm) or by appointment. At pick up, free instructional support can be provided. A Loan Contract must be signed by the person who is financially responsible for item(s) if lost, stolen, or damaged. Please fill out this inquiry form and we will do our best to respond within 2-3 business days.
All loans are FREE of charge. We welcome donations to help maintain and update our equipment. Thank you!
AT User's Name (if different)
AT User's Age
Preferred method of contact
I am a...
Person with a disability
Family member of person with a disability
If you responded "person with a disability" or "family member": Do you have a therapist, teacher, or another person with whom you are working to identify AT? If so, please provide name and title of person. If not, are you interested in learning about where to go for an AT assessment or consultation?
If you responded "care provider" or "professional": What is your title and organizational affiliation?
I am interested in borrowing...
iPad Pro - Large
Keyguard for iPad
Microsoft Surface Pro Tablet
Chromebook - HP
Augmentative & Alternative Communication (AAC) app (inquire for specifics)
Educational/Learning or Play Software
Educational/Learning or Play Apps
Dragon Naturally Speaking Software
Speech Generating Device (inquire for specifics)
Switches (inquire for specifics)
Switch Interface for Computer Access
Switch Interface for iPad Access
Eye Gaze Module for Computer
Alternative Hand Mouse
Adaptive Keyboard - Large
Adaptive Keyboard - Small
Keyguard for Large Adaptive Keyboard
Environmental Control Unit (for switch operating lamps, fan, battery-operated toys, etc.)
Switch Adapted Toys (coming soon!)
Talking/Reminder Alarm Clock
Mount for Switches or Tablet
GoBabyGo Adapted Ride-on Car
Permobil Explorer Mini - powered mobility for ages 1-3 (coming soon!)
Is there anything else you would like us to know? Feel free to add more detail about the AT you are looking to try.
How did you find out about the AT Lab Loan Closet?
A copy of your responses will be emailed to the address you provided.
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