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iPad Loan Form
iPad Loan form including Augmentative Communication Device (AAC) and Speech Generating Device (SGD) trial.
Section 1: Speech and Language Pathologist Information
Name of Speech and Language Pathologist
Company Name [if applicable]
Shipping Address
City
State
Zip
Contact Phone Number [include area code]
Email Address
Form Filled Out By, First Name, Last Name
Enter the first and last name of the person who filled out this form.
Section 2
Device Size (please select one)
iPad (9.7 inch or 10.2 inch)
iPad Pro (11 inch or 12.9 inch)
Requested AAC Apps
LAMP Words for Life
Avaz
Speech Assistant AAC
Proloquo2go
Touch Chat with Word Power
GoTalk Now
Predictable
TD Snap
Flexspeak
Other Requested Apps
Please select the Accessories or Features you would be interested in exploring.
Bluetooth Speaker
Tobii Speech Case
Case with a Stand
Stylus
Mounting Systems
Switch Access
Keyboard
Mouse or Joystick
Built-in Accessibility Features
Other Requested Accessories or Features
CAPTCHA
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