Tech Lending for CPS & CPPS Trainings

If you are participating in a Certified Peer Specialist or Certified Parent Peer Specialist training, you may have received an email outlining tech lending. Please reference that email to check the deadline for which the below form needs to be submitted in order put in a request for tech lending for your training.

Tech Lending Request Form

Access to Independence, the agency that oversees the Wisconsin Peer Specialist Employment Initiative, maintains a small number of tablets and WIFI hotspots that are available to participants in Certified Peer Specialist and Certified Parent Peer Specialist trainings around Wisconsin. When needed, this equipment can be loaned out to participants in order to engage effectively with the training in which they are participating. While utilizing this equipment for the purpose of training, it is important to keep in mind that the tablet and/or WIFI hotspot that has been loaned is the property of Access to Independence and only intended to be utilized for training. In order to ensure this, guidelines have been laid out below regarding the use of the equipment.

This Equipment (Tablet and / or WIFI Hotspot) May be Utilized for the Following:

1. Accessing Zoom software in order to participate in Certified Peer Specialist or Certified Parent Peer Specialist training

2. Accessing Zoom software in order to connect with other training participants for the purpose of practicing the skills developed during training

3. Accessing Microsoft Word for the purposes of notetaking

4. Accessing the internet to review material relevant to Certified Peer Specialist or Certified Parent Peer Specialist training

This Equipment (Tablet and / or WIFI Hotspot) May NOT be Utilized for the Following:

1. Making online purchases of any kind

2. Accessing inappropriate content including, but not limited to: pornography, gambling, purchasing firearms, etc.

3. Use by anyone other than the person participating in the training for which the equipment was loaned

4. Storage of personal data including, but not limited to: credit card information, personal login information, etc.

Upon completion of the Certified Peer Specialist or Certified Parent Peer Specialist for which this equipment has been loaned it will be returned to Access to Independence within one week (7 days) using the return shipping that has been included. In the event that the equipment is not returned in a timely manner, or is returned damaged, non-functional, or in otherwise worse condition that when it was loaned, Access to Independence reserves the right the pursue the full cost of the equipment from the person to whom it was loaned.
Your Information
First Name*
Last Name*
Address*
City*
Zip Code*
Primary Phone Number*
Email*
Enter Email Confirm Email
Please indicate the technology equipment you are requesting:*
- Tablet
- WIFI hotspot
Nature of Technology Needs*
Please use this spot to describe what your needs are. Do you have WIFI, but live in a rural area and are worried about connectivity being consistent? Do you have a computer, tablet, and/or WIFI but lack a functioning webcam? This information will help us better identify how to meed participant needs.
Training Number or Type*
Please enter your 5 or 6 digit training number, or indicate which specific CPS or CPPS training you are attending.
Assurances
Please Indicate the Understandings and Agreements that Hold True to You when Requesting Tech from WIPSEI and ATI:*
- I agree to use loaned equipment only for its intended uses as outlined above.
- I understand that upon completion of the Certified Peer Specialist or Certified Parent Peer Specialist training for which this equipment has been loaned it will be returned to Access to Independence within one week (7 days) using the return shipping that has been included.
- I understand that upon completion of the Certified Peer Specialist or Certified Parent Peer Specialist training, a Certificate of Completion will not be issued for me until the equipment is returned.
- I understand that in the event that the equipment is not returned in a timely manner, or is returned damaged, non-functional, or in otherwise worse condition that when it was loaned, Access to Independence reserves the right the pursue the full cost of the equipment from the person to whom it was loaned.
- I understand that Access to Independence cannot guarantee requested technology, due to a limited lending inventory.
Digital Signature (Type Full Name)*

By signing below you are acknowledging that you have read and agree to adhere to the guidelines laid out above.
Comments
This field is for validation purposes and should be left unchanged.

Tech Lending Request Form

Your Information

Assurances

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