PATINS Lending Library Loan Evaluation
This short evaluation is required for EACH item borrowed from the PATINS Lending Library. The information you provide helps us offer better recommendations about equipment for future users and also to justify the time, effort and resources needed to maintain the lending library. Thank you.
RETURN SHIPPING
Return UPS Shipping Insurance is now at the discretion of the sender. Please return all borrowed items/devices to the site that they were shipped from to you.
Southwest PATINS Northwest PATINS
3711 Casey Road 2150 West 97th Place
Newburgh, IN 47630 Crown Point, IN 46307
* Required
Which PATINS site did you receive borrowed items?
*
SW
NW
School Corporation & School/Agency Name
*
Your answer
Item/Device Evaluation: Please fill out an evaluation for EACH item borrowed.
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Item/Device Name
Your answer
Please check ALL that apply
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First Time Borrower from PATINS
I borrowed to Improve access to the curriculum
I borrowed to Improve classroom participation
I borrowed to Improve computer access
Required
Student Age(s)
*
Choose
0-4
5-11
12-14
15-21
Primary Disability(s) of Student(s)
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ASD - Autism
BLV - Blind/Low Vision
CD - Cognitive Disability
DHH - Deaf/Hard of Hearing
DB - Deaf/Blind
DD - Developmental Delay
ED - Emotional Disability
LSI - Language/Speech Impairment
MD - Multiple Disability
OHI - Other Health Impairment
OI - Orthopedic Impairment
SLD - Specific Learning Disability
TBI - Traumatic Brain Injury
No Documented Disability
Other:
Required
Did you borrow this item with the intent to improve access to literacy activities?
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Yes
No
Was there an improvement in Literacy access as a result of borrowing this item?
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Remarkable improvement in literacy access
Some improvement in literacy access
No improvement in literacy access
Was Borrowed Item appropriate for the student?
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Yes
No
Did the student's academic achievement improve as a result of using Borrowed Item?
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Yes
No
Did the student's behavior improve as a result of using Borrowed Item?
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Yes
No
Did the student's participation in general ed. increase as a result of using Borrowed Item?
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Yes
No
If there was improvement, please provide information regarding success.
If there was not, do you have any insights as to why it didn't?
Your answer
Please Check All That Apply:
*
I have or will request that my school/district purchase this equipment/materials, or something similar, to use with the student.
I need purchasing information.
I am not requesting a purchase at this time.
Required
Rate Us!
*
Please rate your satisfaction with the service that the PATINS Site provided.
Poor
OK, But Needs Improvement
Just Good Enough
Great
Excellent
Please feel free to share any additional comments:
Your answer
Would you or your staff/colleagues like any FREE training or consultation that PATINS can provide for you?
If so, please provide specific training needs and contact information. We will be happy to assist you.
Your answer
We sometimes use borrower's comments or feedback for our website to provide personal experiences of devices/equipment use and our services for other educators. May we use yours?
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Yes, I don't mind.
I'd rather not.
Do you have another item/device that you need to evaluate?
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Yes
No
First and Last Name
*
Your answer
Your Email:
*
Your answer
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