Assistive Technology of Ohio Device Lending Library
Thank you for taking a few moments to help us by filling out this important survey.
Name (Last, first)
What library did you check out the device / toy from?
Please select from the drop-down list
Assistive Technology of Ohio - State Office
Adams Co. - Peebles
Allen Co. - Lima
Auglaize Co. - Cridersville
Auglaize Co. - Minster
Auglaize Co. - New Bremenr
Auglaize Co. - New Knoxville
Auglaize Co. - St. Mary
Auglaize Co. - Wapakoneta
Auglaize Co. - Waynesfield
Carroll Co. - Carrollton
Champaign Co. - Urbana
Champaign Co. - Saint Paris
Crawford Co. - Bucyrus
Fairfield Co. - Lancaster
Fairfield Co. - Wagnalls Memorial Library
Gallia Co. - Gallipolis
Harrison Co. - Cadiz
Highland Co. - Hillsboro
Jefferson Co. - Steubenville
Lawrence Co. - Ironton
Mercer Co. - Celina
Meigs Co. - Pomeroy
Miami Co. - Tipp City
Miami Co. - Troy
Montgomery Co. - Oakwood
Noble Co. - Caldwell
Preble Co. - El Dorado
Shelby Co. - Sidney
Scioto Co. - Portsmouth
Tuscarawas Co. - Gnadenhutten
Van Wert Co. - Van We
Vinton Co. - McArthuretta
Washington Co. - Marietta
Wyandot Co. - Carey
What is the name of the toy you checked out?
Please check out the name on the toy...
What category of person checked out this device or toy?
Individual with disabilities
Family members / guardian / authorized representative
Representative of Education
Representative of Employment
Representatives of Health / Allied Health / Rehabilitation
Representatives of Community Living
Representatives of Technology
What was the primary purpose for checking out this device?
To assist me in making an informed decision on what devices to buy
To serve as a loaner device during repair or while waiting for funding
To provide an accommodation on a short-term basis
What area of life will this device/ toy help with?
This device will help in the area of...
Learning, cognition and developmental issues
Mobility, seating and positioning
Vehicle modifications and transportation
Computers and related
Leisure, recreation and sports
What area will the device / toy be used in?
Please select the area of life the device is going to be used in...
What answer best describes the experience of the borrower?
The assistive technology device will meet my needs
The assistive technology device will not meet my needs
I have not made a decision
How would you rate your level of satisfaction with the device borrowed?
Not at all satisfied
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