Get Service & Device Application - Assistive Technology Partnership

Filling out the Service & Device Application - Assistive Technology Partnership is an essential step for individuals seeking assistance with funding for home modifications, technology, or services related to disabilities. This guide will provide you with clear, step-by-step instructions to help you complete the application accurately and efficiently.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it for filling out.
2. Provide your personal information in the required fields, including your name, date of birth, and contact information. Ensure that you include your Social Security number and specify your disability.
3. Identify the services and devices you are requesting. List them in order of importance, along with estimated costs if known.
4. Indicate your housing status by checking the relevant boxes and provide information about your home ownership or rental situation, including your landlord's details if applicable.
5. Fill in your financial information, detailing your income sources and any assets you possess. It is important to be as precise as possible to assist in determining your eligibility.
6. Complete the release/agreement form at the end of the application by providing a signature and the date, acknowledging the accuracy of the information provided.
7. Review the entire application for completeness and accuracy before submission.
8. Once satisfied, print the completed form. Note that the application cannot be submitted online or saved electronically.
9. Submit your completed and signed form to the Assistive Technology Partnership at the provided address.

Start your application today to access funding for the support you need.