1. FAAST Statewide Assistive Technology Device Loan Program Survey

Thank you for participating in the FAAST Statewide Assistive Technology Device Loan Program to loan assistive technology devices to individuals with disabilities. In order to loan assistive technology devices, federal reporting requirements require that we ask all participants to complete the following survey. Your feedback is very important as it allows us to continue to improve the FAAST Statewide Assistive Technology Device Loan Program to loan assistive technology devices to individuals with disabilities. Please take a moment to complete this brief survey. To save time and to reasonably accommodate you, we can also conduct this survey verbally or through an accessible format of your choice.

Question Title

* 1. Please select the category that most closely describes the individual or entity borrowing an assistive technology device:

Question Title

* 2. Please select the primary purpose or need of the loan:

Question Title

* 3. Please select the category that best describes the type of assistive technology device that was loaned to you:

Question Title

* 4. Please select the primary reason the loaned assistive technology device was needed:

Question Title

* 5. Please select the primary purpose for which an assistive technology device loan was needed:

Question Title

* 6. Please select the following option that best describes your level of satisfaction with the assistive technology device loaned:

Question Title

* 7. You may choose to remain anonymous. For quality assurance purposes, please provide us the following information:

Under HIPAA, information within this survey is confidential. Use, distribution, and reproduction of this survey, access to and action taken in reliance upon this survey by unauthorized recipient(s) other than FAAST, Inc., the FAAST Regional Demonstration Centers, and our funders is not authorized.

T