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

Which PATINS site did you receive borrowed items? *
School Corporation & School/Agency Name *
Your answer
Item/Device Evaluation: Please fill out an evaluation for EACH item borrowed. *
Item/Device Name
Your answer
Please check ALL that apply *
Required
Student Age(s) *
Primary Disability(s) of Student(s) *
Required
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?
Your answer
Please Check All That Apply: *
Required
Rate Us! *
Please rate your satisfaction with the service that the PATINS Site provided.
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? *
Do you have another item/device that you need to evaluate? *
First and Last Name *
Your answer
Your Email: *
Your answer
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