V-LINC - Providing Independence through Technology -

Address *

Phone Number *

E-Mail Address *

Are you making this request on behalf of someone else? Yes No *

Date of Birth *

Primary Disability *

Secondary Disabiltiy (if applicable)

Please describe how this person's disability effects their life *

Please describe in as much detail as possible your request for a customized solution.

Once we receive and process your request, it will be reviewed to determine if it is something our engineers can do, if it is safe to do, and whether a commercially available solution might fit the need.  During this process we may contact you for additional information, which may include an onsite visit.

If a product is commercially available we will provide you with information on how to acquire the item or put you in contact with one of our Assistive Technology Specialists.  If it is determined that no commercially available product will meet your need and that our volunteer engineers can safely and effectively create a solution, we will take on your project.

Request *