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Assistive Technology Financing Program Loan Application

Instructions

The application has three parts:

Part 1: About You/Your Co-Applicant

Part 2: Disability/Assistive Technology Information

Part 3: Financial Information

In addition, you must provide a written quote from the vendor/contractor from whom you plan to purchase the assistive technology device or service.

You must complete all parts in order for your application to be processed.

Some Important Definitions

Disability – a physical or mental impairment that substantially limits one or more major life activity, such as caring for one’s self, performing manual tasks, seeing, hearing, speaking, learning and working.

Applicant – the person who borrows the money and is responsible for the re-payment of the loan. This may be the person with a disability or a family member/guardian/friend.

Co-applicant – another individual who will also be responsible for payment of the loan. The information provided by the co-applicant, as well as the applicant, will be used to determine whether a loan is granted. A co-applicant is helpful if the applicant has very limited financial resources.

Some of the questions in the application are designed to help you decide if you are sure that you’ve chosen the best assistive technology available for your needs. If you aren’t sure, we can refer you to people who can assist you.

Because we are trying to reach all Pennsylvanians with disabilities who could benefit from this program, we ask a few questions about the person who will be using the assistive technology, such as age, race, and county of residence. These questions are optional and do not affect your ability to get a loan.

If you require assistance to complete the application, please call our toll-free number: 800-204-7428 (Voice) or 800-750-7428 (TTY).

Once you have completed the application including a written quotation, return the application packet to:

The Pennsylvania Assistive Technology Foundation
c/o Institute on Disabilities/UAP
Ritter Annex 423
1301 Cecil B. Moore Avenue
Philadelphia, PA 19122

 

Rev 9/00 vds

 


AFTAP/RESNA
1700 North Moore Street, Suite 1540
Arlington, VA 22209-1903
Phone: 703/524-6686  Fax: 703/524-6630  TTY: 703/524-6639
Email: info@resna.org  http://www.resnaprojects.org/AFTAP

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