Request a Demonstration or Device Loan

Use this form to request a device demonstration or short-term device loan. Your inquiry will be forwarded to the appropriate staff member, and you will be contacted shortly.

Name * First Last
Phone * - (###) - ### ####
Zipcode *
Email
Please choose the option that best describes you * Individual with disability Family member, guardian, representative Education representative Employment representative Health, allied health, or rehabilitation representative Community living representative Technology representative
Nature of Inquiry * Equipment Demonstration Short-term Device Loan Other
Categorize your inquiry as best you can. this will help us assist you more quickly.
Please tell us more about the type of device you are interested in seeing or borrowing.