MN Resource Libraries AT Loan Program Trial Data & Information
In order to justify the expenditure of WIOA funds for high cost assistive technology, please complete this survey after borrowing AT equipment for students who are age 14 and above. Please do NOT include any student specific identifiable information other than age of student in this survey. No student names are necessary.
Date of request:
Your answer
Name of TBVI or COMS:
Your answer
Age of student for whom equipment is being borrowed:
Your answer
Name of AT device trialed:
Your answer
Length of time the device was trialed with the student in the intended environment/s?
Your answer
Was a device purchased for the student as a result of the AT Loan Program?
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