STC Lending Library Form: Suggest a Purchase

This form provides the opportunity to suggest an AT item for the STC library to purchase and add to our inventory.

*Submitting a suggestion does not guarantee that we will purchase the item for our library.

**We generally do not include the following types of items in our AT library: durable medical equipment (DME), general non-AT related items, consumable products, software/program license that are non-transferable, items or programs that require a therapist to administer or prescribe, and we are cautious with purchasing items that have sanitary concerns.

***If you have any questions about the form, please contact us at stclibrary@pacer.org or at 952-838-1400.

Question Title

* 1. Are you a STC library member?

Yes

I am a former member

I am considering joining or renewing membership

Other (please specify)

Question Title

* 2. Library membership username, or ID#

Question Title

* 3. Your name (first and last):

Question Title

* 4. Your phone number:

Question Title

* 5. Your email address:

Question Title

* 6. Preferred contact method:

Question Title

* 7. Who is this request for?

Question Title

* 8. There are other AT lending libraries in Minnesota that might have this item you are suggesting to us. Which libraries have you checked with?

PACER, Simon Technology Center, AT Lending Library, Minneapolis

Minnesota STAR Program, St. Paul

Lighthouse Center for Vital Living, Duluth

North Dakota Assistive, Fargo

Regional Assistive Technology Center (RATC), Moorhead

Southeastern Minnesota Center for Independent Living (SEMCIL), Rochester

Other (please specify)

None of the above

Question Title

* 9. Name of the AT Item or Product:

Question Title

* 10. Version and/or model name of the product (if available or known):
(Example: the Livescribe Smartpen Echo 2 is the full name of a product. Here are the parts of the name identified: Livescribe (company) Smartpen (name) Echo (model) 2 (version)):

Question Title

* 11. What kind of AT is this item?

Device (any physical tangible item such as: keyboard, adapted toy, assistive paper, adapted scissors, writing grip, magnifier, communication device, etc.)

iOS app (iPad app)

Software

Book

Other (please specify)

STC Lending Library Form: Suggest a Purchase

Question Title

* 1. Are you a STC library member?

Question Title

* 2. Library membership username, or ID#

Question Title

* 3. Your name (first and last):

Question Title

* 4. Your phone number:

Question Title

* 5. Your email address:

Question Title

* 6. Preferred contact method:

Question Title

* 7. Who is this request for?

Question Title

* 8. There are other AT lending libraries in Minnesota that might have this item you are suggesting to us. Which libraries have you checked with?

Question Title

* 9. Name of the AT Item or Product:

Question Title

* 10. Version and/or model name of the product (if available or known):
(Example: the Livescribe Smartpen Echo 2 is the full name of a product. Here are the parts of the name identified: Livescribe (company) Smartpen (name) Echo (model) 2 (version)):

Question Title

* 11. What kind of AT is this item?

Question Title

* 12. Name of Manufacturer (the company, or business):

Question Title

* 13. Where can this item be purchased?

Question Title

* 14. Price:

Question Title

* 15. Website for this product information or purchase:

Question Title

* 16. Reason or purpose for your suggestion?

Question Title

* 17. Any questions or comments? (response optional)

Question Title

* 1. Are you a STC library member?

Question Title

* 2. Library membership username, or ID#

Question Title

* 3. Your name (first and last):

Question Title

* 4. Your phone number:

Question Title

* 5. Your email address:

Question Title

* 6. Preferred contact method:

Question Title

* 7. Who is this request for?

Question Title

* 8. There are other AT lending libraries in Minnesota that might have this item you are suggesting to us. Which libraries have you checked with?

Question Title

* 9. Name of the AT Item or Product:

Question Title

* 10. Version and/or model name of the product (if available or known):(Example: the Livescribe Smartpen Echo 2 is the full name of a product. Here are the parts of the name identified: Livescribe (company) Smartpen (name) Echo (model) 2 (version)):

Question Title

* 11. What kind of AT is this item?

Question Title

* 12. Name of Manufacturer (the company, or business):

Question Title

* 13. Where can this item be purchased?

Question Title

* 14. Price:

Question Title

* 15. Website for this product information or purchase:

Question Title

* 16. Reason or purpose for your suggestion?

Question Title

* 17. Any questions or comments? (response optional)

* 10. Version and/or model name of the product (if available or known):
(Example: the Livescribe Smartpen Echo 2 is the full name of a product. Here are the parts of the name identified: Livescribe (company) Smartpen (name) Echo (model) 2 (version)):