Steps you need to take

Assistive Technology Loan Application: Part 2

Steps You Need to Take

Prepare Your Individual Assistive Technology Plan

1. Your Individual Assistive Technology Plan (IATP) will explain:

Your reason for needing the equipment/device
Your disability
How you anticipate the equipment/device will improve your situation
The device name, model, why you need this specific model, vendor and price (if known)
Other funding source (if known)
Plans for training and follow-up.

2. Your Personal Monthly Budget Worksheet includes figures for the following:

All sources of income
Monthly amount available to repay loan
[Subtract your monthly expenses from income to determine net monthly disposable income. The amount available for monthly loan payments equals 50% (one-half) of your net monthly disposable income.
Additional information on income expenses
Any lump sum distributions, etc.

3. Your Loan Application includes the following information:

Amount of loan you are requesting
Repayment source (i.e. Social Security, earnings, etc.)
Desired payment schedule (number of months to repay the loan)
Technology/equipment/device
Name, social security number, date of birth, number of dependents
Address, length of residence, monthly rent/mortgage
Length of time at previous address, monthly rent/mortgage
Employer, address, occupation, length of employment, phone
Previous employer, address, occupation, length of employment, phone
Nearest relative
Annual Income/Liabilities
Bank accounts/securities/real estate/credit reference/alimony/child support
Bankruptcy
Disclaimer/Signature

Your should organize and gather as much of the above information as possible. A Peer Technology Counselor at on of the Independent Living Centers (ILCs) can help you complete the application. (See form 3 for addresses, phone numbers and location on the map.) Please call to make an appointment with the Peer Technology Counselor to verify he or she will be available to see you.

4. Mail Your Application

If you do not need to meet with a counselor from one of the ILCs and you wish to mail your completed application directly to the bank, please mail it to:

Beverly Hoppie, Community Development Officer
People�s Bank, Community Lending
Bridgeport Center, 850 Main Street, RC-295
Bridgeport, CT 06604-4913

If you need to contact Ms. Hoppie by phone, she can be reached at 203-338-2490.

Independent living centers