STAR Device Loan Survey for STC Lending Library

Because you are requesting a demonstration or loan of assistive technology services, we are asking you to provide information about yourself on this form. If you are requesting services on behalf of another, we will need additional information about that person.  We and our State funder (MN STAR Program) will use this information to administer and evaluate this program.  By providing this information you agree that our State funder (MN STAR Program) may contact you about the services you received.  Providing this information is voluntary and will allow you to receive these services.  If you choose not to provide this information, we cannot provide you or your family member these services.

Any data that identifies you will be protected as private data.  We can only share the information as described in this notice or with your permission. By law, information can be shared with the Legislative Auditor and the Attorney General in the case of litigation.  Information you provided would also be shared or released if a court orders it or a future state or federal law requires it.

By signing below, I indicate that I have read and understand the Tennessen Notice and that my information may be shared with the MN STAR program.