STATE loan bank request form
Please use this form to request AT from the STATE loan bank. (sponsored by SWAAAC / ATP) There is an online catalog available for you to view what they have: https://swaaac.goalexandria.com/ This is NOT the local SJBOCES loan bank. All equipment from this loan bank is available for a one month loan period which is strictly enforced. There may be a waiting list for some equipment.

If you want to request an item from the local SJBOCES loan bank go here: https://docs.google.com/spreadsheet/viewform?hl=en_US&formkey=dEFwMjRkR0tzR05vWmt1aUxDZ0puMmc6MQ#gid=0

Item(s) you are requesting: *
Please use the exact name shown in the loan bank catalog.
Your answer
Your Name: *
Your answer
Your email address: *
Your answer
The initials of the student you are requesting this device for: *
Your answer
Student's Age *
Your answer
Student's Gender *
Diagnosis *
I know this is not an all inclusive list, but this is what they give me to chose from.
Is this a low or high incidence disability: *
Your guess is as good as mine, they don't provide any guidance on this.
Ethnicity: *
County: *
School: *
Your answer
Is this loan for: *
If Professional Development:
Primary Purpose: *
Primary used to assist: *
Comments:
Your answer
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