Assistive Technology Lending Center

Personal Contact Information
First Name*
Last Name*
Home E-mail*
Home Phone
(i.e. 999-999-9999)
*
Cell Phone
(i.e. 999-999-9999)
*

Shipping Information
School Name*
Address*
City*
State*
Zip Code*

Work Information

School/District Name
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CESA Agency *
Position(s) *
Grade Levels *

Phone
(i.e. 999-999-9999)
*Ext
Fax*
E-mail
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Password
Must be at least 6 characters
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Password Again
Passwords are case sensitive
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Preferences / Additional Information

Contact Notice/Policy It is important that you select a contact method for your future web site use. We will only email/notify you to remind you items are due back and/or are over-due. We will attempt to contact you via email at first. If this fails, we will than contact you by the information provided.

I would like to be contacted via *

ATLC Lending Library Policy * Only Wisconsin LEA public school licensed professional educators may check out AAC devices for use with children ages 3-18 who have IEPs and are enrolled in public schools or students age 19-21 who are enrolled in a Wisconsin LEA school program and have an IEP. You should check with your regional AT consultant prior to checking out AAC devices to assure you are borrowing a device appropriate for the targeted student. Devices may be renewed once for an additional 1-3 wks. loan providing the devices are not on reserve for others. If an AAC device is unavailable, you may put your name on a reserve list for when it becomes available. If your school district or agency has already borrowed the device during this school year, other requesters will be given priority, moving your name further down the reserve list. All AAC devices must be returned on/before the due date. You will be notified via email if the device becomes overdue. If the device is not received at ATLC within three days, a second notice will be sent to you and copied to your principal/supervisor. You will be prohibited from borrowing additional devices from the lending library until the device is received at ATLC. You must return devices CLEAN and in working order; return equipment IMMEDIATELY if it ceases to operate; contact the ATLC staff if items are missing from the packing list. Complete the data report/evaluation form included with your device(s). You will be required to reimburse the ATLC Lending Library at the current market value if the device is lost, has missing parts, or is damaged beyond repair. If the device can be repaired, you will be responsible for the repair costs. OBEY SOFTWARE COPYRIGHT LAWS. Absolutely no copying of disks. You must remove borrowed programs from all computer hard disk drives upon returning software.

I agree to the above policies*Yes

Assistive Technology Lending Center

Personal Contact Information

Shipping Information

Work Information

Preferences / Additional Information