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! https://cv-atlab.org/get-involved/donate/
Email address *
Your Name *
Your answer
AT User's Name (if different)
Your answer
AT User's Age *
Phone number *
Your answer
Preferred method of contact
City, State *
Your answer
I am a... *
Required
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?
Your answer
If you responded "care provider" or "professional": What is your title and organizational affiliation?
Your answer
I am interested in borrowing... *
Required
Is there anything else you would like us to know? Feel free to add more detail about the AT you are looking to try.
Your answer
How did you find out about the AT Lab Loan Closet?
Your answer
A copy of your responses will be emailed to the address you provided.
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