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 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
Which PATINS site did you receive borrowed items? *
School Corporation & School/Agency Name *
Item/Device Evaluation: Please fill out an evaluation for EACH item borrowed. *
Item/Device Name
Please check ALL that apply *
Student Age(s) *
Primary Disability(s) of Student(s) *
Did you borrow this item with the intent to improve access to literacy activities? *
Was there an improvement in Literacy access as a result of borrowing this item? *
Was Borrowed Item appropriate for the student? *
Did the student's academic achievement improve as a result of using Borrowed Item? *
Did the student's behavior improve as a result of using Borrowed Item? *
Did the student's participation in general ed. increase as a result of using Borrowed Item? *
If there was improvement, please provide information regarding success.
If there was not, do you have any insights as to why it didn't?
Please Check All That Apply: *
Rate Us! *
Please rate your satisfaction with the service that the PATINS Site provided.
Please feel free to share any additional comments:
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.
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? *
Do you have another item/device that you need to evaluate? *
First and Last Name *
Your Email: * logo
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