How to Receive Services-Related Forms

These forms may be printed, filled out by hand, and mailed to:

UCP Michigan Assistive Technology Center
321 E. Ohio St.
Marquette, MI 49855

Or they may be saved to your computer, filled out electronically, and e-mailed to:

menzel@ucpmichigan.org

School Related Assessment Forms

• Assesment Request
• Current Functional Status
• Assistive Technology Planning Guide
• Assistive Technology Checklist
• Authorization for Disclosure from Schools
• Authorization for Disclosure of Information
• Audio-Visual Release

Non-School Related Assessment Forms

• Referral Information
• Authorization for Disclosure of Information
• Audio-Visual Release