Get the free Assistive Technology Request Form - wvdhhrorg

WV BIRTH TO THREE Office of Maternal, Child and Family Health Bureau for Public Health Department of Health and Human Resources Child's Name: Date of Birth: Diagnosis (if applicable): Assistive Technology

How to fill out assistive technology request form

1. Gather the necessary information: Before filling out the assistive technology request form, gather all the relevant information that will be required. This may include personal details such as name, contact information, and student or employee ID number, as well as specific information about the type of assistive technology needed.
2. Read the instructions carefully: Make sure to read the instructions provided with the form thoroughly. This will help you understand the purpose of the form, the required information, and any specific guidelines or requirements.
3. Fill in personal details: Start by filling in your personal details such as your name, address, phone number, and email. Provide any identification numbers or relevant information as requested.
4. Describe the assistive technology needed: In a separate section or field, clearly describe the specific assistive technology you are requesting. Be as detailed as possible, providing information on the type of disability or limitation you have, and how the requested technology will assist you.
5. Provide supporting documentation: If required, attach any supporting documentation that may support your request. This can include medical records, assessments, or recommendations from professionals.
6. Submit the form: Once you have filled out all the required sections of the assistive technology request form and attached any necessary documentation, review the form for accuracy and completeness. Make sure all the fields are filled out correctly and that you haven't missed any required information.
7. Submit the form as instructed: Follow the instructions on the form to submit it to the appropriate office or department. This may involve submitting it online, sending it through mail, or hand-delivering it to a specific location.

Who needs assistive technology request form?

1. Students with disabilities: Students who require assistive technology to support their learning or accessibility needs may need to fill out an assistive technology request form. This can include students with visual impairments, hearing impairments, learning disabilities, or physical disabilities.
2. Employees with disabilities: Employees who require assistive technology in the workplace to perform their job duties effectively may also need to complete an assistive technology request form. This can include employees with mobility impairments, communication difficulties, or other disabilities that require specialized technology.
3. Individuals seeking accessibility accommodations: In some cases, individuals who are not students or employees but require assistive technology for accessibility purposes may also need to fill out an assistive technology request form. This can include visitors to a public facility or individuals accessing certain services or resources.

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What is assistive technology request form?

Assistive technology request form is a form used to request technology or devices that will assist individuals with disabilities in performing certain tasks or activities.

Who is required to file assistive technology request form?

Individuals with disabilities who require assistive technology to aid in their daily activities are required to file the assistive technology request form.

How to fill out assistive technology request form?

To fill out the assistive technology request form, individuals need to provide their personal information, details of the technology needed, and a description of how it will help them.

What is the purpose of assistive technology request form?

The purpose of the assistive technology request form is to ensure that individuals with disabilities have access to the technology they need to live independently and perform tasks effectively.

What information must be reported on assistive technology request form?

The information required on the assistive technology request form includes personal details, description of disability, type of technology required, and how it will be beneficial.