Statement of Agreement Form

The purpose of the CED Loan Library is to provide short term access to resources for individuals looking for supports and services.

Books, resource materials, videos and CDs can be borrowed from the CED Resource Center. Assistive Technology devices/equipment can be borrowed from the West Virginia Assistive Technology System (WVATS).

The program is time-limited to assure maximum availability of the resources and devices for all borrowers. The loan period is 30 days (monthly), unless otherwise indicated.

To borrow CED resources or assistive devices, the borrower must complete the bottom portion of this form and sign and date the Statement of Agreement.

Statement of Agreement

I have read and understand the CED Loan Library statement above. I agree to keep the borrowed resource in good condition and return it by the due date. If I am borrowing an assistive device, I have been instructed how to operate the equipment and agree not to hold WVATS responsible for any injuries that may occur from improper use of the device/equipment. I also agree to participate in any follow-up evaluations from CED staff regarding my satisfaction with the CED Loan Library.








Select the answer that best describes the borrower

Individual with a disability
Family / Guardian / Representative
Professional in
      Education
      Employment
      Health / Rehabilitation
      Community Living
      Technology

Select the answer that best describes the purpose of this loan

Assist in decision making (trial, evaluation, etc.)
Serve as a loaner during device repair or while waiting for funding
Provide an accomodation on a short-term basis
Other



Online users please acknowledge your acceptance of the terms stated above. (required)

I agree with the terms as stated above.

(Note: You must acccept the terms in order to check items out of the WVATS Virtual Loan Library)

Check Out Information
(To Be Completed By Staff)












Return Information (To Be Completed By Staff)







  

If you prefer, you may print this form and return it to WVATS by fax or mail. To print, please use your brower's print command or click

Forms may be mailed or faxed to:

West Virginia Assistive Technology Systems (WVATS)
Center for Excellence in Disabilities
959 Hartman Run Road
Morgantown, WV 26505
Fax: (304) 293-7294