Oklahoma ABLE Tech Success Story & Photo Release Form

Oklahoma ABLE Tech appreciates your support in submitting your experiences using assistive technology (AT). We utilize this information to understand better how a person’s journey is improved through participating in our Assistive Technology Programs.

Your story can help others!

* Indicates Required Field

Today's Date (automatically created):

First and Last Name

Age of Individual:

City:

County:

What type of disability(s) do you (or the person you are completing this for) live with? (No need to be technical or use clinical language; feel free to use everyday language to describe your experience.)

How long have you (or they) had this disability?

What ABLE Tech Program did you use?

What other ABLE Tech Program did you utilize?

How did you learn about this program?

What assistive technology or equipment was received, demonstrated, or trialed?

In what environments did the individual use the AT? Check all that apply.

Education/Classroom Employment Community/Home

How is the AT being used to improve the quality of your life and ability to live, learn, work, and/or play? (Specific examples are always very helpful, i.e. “Before AT I was unable to read my favorite book on my own, but now I can read my book at my own leisure” or “I can now attend activities in my community that I couldn’t do before!” or “I can hear my grandchildren now”.)

Now that you have received these devices or services, what goals or hopes do you have for the future? (Examples: I plan to play bridge club again; or, I hope to get a job, and/or go to college - connecting it back to improved quality of life (live, learn, work, play). Also, how are these goals different from the goals you had prior to receiving this AT or equipment?)

Do you have any additional comments you’d like to provide?

If we have additional questions, may we contact you?

Yes No

Please provide the best phone number or email address.*

Consent for ABLE Tech Success Story and Photo Release

I give Oklahoma ABLE Tech permission to use my story, likeness, image, voice, and/or appearance as such that may be embodied in any photos and video recordings, on behalf of the ABLE Tech programs. I agree that ABLE Tech has complete ownership of such content and photos. I acknowledge that I will not receive any compensation for the use of the submitted information and photos which will be used for ABLE Tech promotional purposes.

Please call ABLE Tech if you have questions at 1.800.257.1705 or email us at abletech@okstate.edu.

Let us see you in action using the AT or equipment! Upload your photo here.

No File Chosen

File uploads may not work on some mobile devices.

Type Your Full Name

May we use the individual’s first name with the attached photo and the success story?

Yes No

Thank you for submitting this Success Story!
Learn all about Oklahoma ABLE Tech on our website.