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Referrals for Assistive Technology Assessments and Training

Please submit the following along with this referral form: AT Referral for Services (complete electronically)

• Authorization that commits to payment of the service fee (Example: Purchase Order, Agency Service Authorization Form, Letter from Authorizing Party)

• Copies of current evaluations/medical information pertinent to this evaluation process. (Example: evaluations from school system, individual educational plans, evaluation�s conducted by private therapists, doctor�s records, etc.)

Fee schedule

• Assistive Technology Assessment are $575.00.                                                  
  

• Individual Trainings are $125.00 per hour.                                                     

• Consultations are $125.00 per hour.                                                             
  

• Group Trainings are $500.00 p/half day (4 hours)/$900.00 p/whole day (8 hours).

• Travel at $50.00 per hour.                                                                            
  

Refer questions to Intake Coordinator at (919) 855-3551 or [email protected]. 

Send Completed Packets To: Intake Coordinator | North Carolina Assistive Technology Program | 2801 Mail Service Center | 805 Ruggles Dr.  | Raleigh, NC  27699-2801

919-855-3564 (Phone)
919-715-1776 (Confidential FAX)
[email protected]

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