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Forms
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Forms
Application for A Communication Device
This form
must
be completed if requesting that OARC provide set-up of a communication device and/or training services
Request for Quote Form
Use this form if requesting a quote for equipment only (
no
set-up or training by OARC)
Client Information Form
Use this form if borrowing a short term loan from OARC
Short Term Equipment Loans
Please contact our Executive Director, Mary-Alex Willer at
mary-alex@oarc.ca
to inquire about a short-term loan.
Application for Eye Gaze communication system
Application forms for Eye Gaze Systems will be provided following a consultation with OARC staff to determine if eye gaze is an appropriate access method. Please CONTACT US to make arrangements.
Request for Quote Form
Client Information Form
Application for iDevice
Short Term Equipment Loans
Please contact Mary-Alex Willer, Executive Director at mary-alex@oarc.ca to inquire about a short-term loan.
Application for Eye Gaze System
Form Name 1
Lorem Ipsum is simply dummy text of the printing and typesetting industry.
Client Name:
Gender:
Male
Female
Date of Birth (MM/DD/YYYY):
Diagnosis:
Parent/Guardian Name :
Phone #:
Your Email
School:
Speech/Language Pathologist:
Your Image
Upload File
Max file size 10MB.
Uploading...
fileuploaded.jpg
Upload failed. Max size for files is 10 MB.
Address:
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
Form Name 2
Lorem Ipsum is simply dummy text of the printing and typesetting industry.
Client Name:
Gender:
Male
Female
Date of Birth (MM/DD/YYYY):
Diagnosis:
Parent/Guardian Name :
Phone #:
Your Email
School:
Speech/Language Pathologist:
Your Image
Upload File
Max file size 10MB.
Uploading...
fileuploaded.jpg
Upload failed. Max size for files is 10 MB.
Address:
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
Form Name 4
Lorem Ipsum is simply dummy text of the printing and typesetting industry.
Client Name:
Gender:
Male
Female
Date of Birth (MM/DD/YYYY):
Diagnosis:
Parent/Guardian Name :
Phone #:
Your Email
School:
Speech/Language Pathologist:
Your Image
Upload File
Max file size 10MB.
Uploading...
fileuploaded.jpg
Upload failed. Max size for files is 10 MB.
Address:
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
Form Name 4
Lorem Ipsum is simply dummy text of the printing and typesetting industry.
Client Name:
Gender:
Male
Female
Date of Birth (MM/DD/YYYY):
Diagnosis:
Parent/Guardian Name :
Phone #:
Your Email
School:
Speech/Language Pathologist:
Your Image
Upload File
Max file size 10MB.
Uploading...
fileuploaded.jpg
Upload failed. Max size for files is 10 MB.
Address:
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
Form Name 5
Lorem Ipsum is simply dummy text of the printing and typesetting industry.
Client Name:
Gender:
Male
Female
Date of Birth (MM/DD/YYYY):
Diagnosis:
Parent/Guardian Name :
Phone #:
Your Email
School:
Speech/Language Pathologist:
Your Image
Upload File
Max file size 10MB.
Uploading...
fileuploaded.jpg
Upload failed. Max size for files is 10 MB.
Address:
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
OARC Communication Device Application Process
Our application process involves a series of steps that users can easily follow to apply for a communication device.
01
Application Received
02
Review Application
03
Match With Funder & Apply For Funds
04
Await Approval Of Funds
05
Order Device & Equipment
06
Set-up Remote Management
07
Assign To Trainer
08
Adjust Settings & Set-Up Communication Apps
09
Connect With Team
10
Schedule & Complete Training
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+1 (204) 949 2430
oarc@oarc.ca
316 Tache Avenue Winnipeg, Manitoba, Canada R2H 2A4
www.oarc.ca