AT Device Reuse Programs Input Form

AT Reuse Program Name:
Organization Operating AT Reuse Program:
Street Address:
City:
State:
Zip Code:
Country:
Phone:
TTY:
FAX:
Toll Free Number:
Website:
Contact Person for Program:
Email for Contact Person:
Hours of Operation:

Type of Reuse Program (check all that apply)

Reassignment of Devices

Refurbish and Reassignment of Devices

"Classified/Want Ads or E-bay-like" Program

Website URL for Classified/Want Ads/e-bay Program:

Type of Reuse Equipment Available (check all that apply)

Vision

Hearing

Speech Communication

Learning, Cognition, and Developmental

Mobility, Seating and Positioning

Daily Living Aids

Environmental Adaptations

Vehicle Modification and Transportation

Computers and Related Devices

Recreation, Sports and Leisure

Cell Phones

Other:

On average, how many devices do you reassign/exchange in a year?

Ages Served:

Disability Served:
All disabilities Disability specific (please specify):

Region of the State Served:

Is there a charge for the device? Yes No

If yes, how much and what is the charge for?

What other services do you provide to support your reuse activities (check all that apply):

Is there a charge for the services? Yes No

If yes, please explain what the charge is for:

Other comments you wish to make about your program:

The National Assistive Technology Technical Assistance Partnership is a cooperative agreement between the U.S. Department of Education and RESNA. The grant (Grant #H224B050003; CFDA 84.224B) is funded under the Assistive Technology Act of 1998, as amended and administered by the Rehabilitation Services Administration, Office of Special Education and Rehabilitative Services at the U.S. Department of Education.

This website is developed with grant funds. The information contained on these pages does not necessarily reflect the policy or position of the U.S. Department of Education or the Grantee and no official endorsement of the information should be inferred.