Use this form to request to meet with a member of the Michigan Assistive Technology Program (MATP) team to learn more about Assistive Technology.  Our services are free—we are a federally funded program.

If you would like assistance with filling out this form, please contact us:
Phone: 1-800-578-0280
Michigan Relay: 711
Email: AT@MyMDRC.org

MATP is a part of Michigan Disability Rights Coalition (MDRC). Our work is by people with disabilities for people with disabilities, their allies, and other community members.

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* 1. I am interested in something for:

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* 2. I am mostly interested in tools and technology for (check all that apply):

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* 3. In the past, have you used something that has worked well or not well for you?  For example: a timer or medication reminder, a magnifier, an app on your smart device, etc.  Please explain

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* 4. Do you need internet or a device to participate in a video call or phone call for the AT demonstration?

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* 5. What is your name?  (first name, last name)

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* 6. How should we contact you?

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* 7. Is there anything you want to ask us or that you want us to know about you?

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* 8. How did you hear about Assistive Technology demonstrations/the Michigan Assistive Technology Program (MATP)?

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