Assistive Technology Financing Program Loan Application

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.

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.