Get Ma Match Device Loan Program Operated - Easter Seals

This guide offers a comprehensive approach to completing the MA MATCH Device Loan Program Form created by Easter Seals. By following these clear steps, you will ensure that your application is completed accurately and efficiently.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the borrower information section which includes your name, organization, mailing address, city, state, daytime phone/TTY, cell phone, email, date of birth, gender, ethnic group, veteran status, and disability classification.
3. Indicate your relationship to the loaning party by checking the option that best applies from the provided list.
4. Next, specify the purpose of the device loan, such as for device trial, loaner during repairs, or short-term accommodation.
5. Choose the primary purpose of the assistive technology device by selecting one from the options provided.
6. List the equipment requested and provide the length of the loan for either 2 weeks, 4 weeks, or note a different duration if applicable.
7. Select the loan start date and indicate if you're able to arrange the pick-up and return of the device from the listed locations.
8. Sign and date the application at the bottom of the form. Ensure the completed form is reviewed for accuracy.
9. Finally, you can save changes, download the filled form, print it, or share it as necessary.

Complete your MA MATCH Device Loan Program application online today to ensure timely assistance.