Maine Developmental Disabilities Council Device Request Form

Please complete this form for each person you refer to the Maine Developmental Disabilities Council Tablet Program. Please complete the referral section, then read each of the questions to the potential device recipient and record their answers. Please indicate if there are any special circumstances or questions regarding the appropriateness of this referral.

    If the person being referred for a device is definitely not an adult Maine resident with a developmental disability, please do not continue with this application.
    This is a requirement of the MDDC devices program. The classes are FREE and you can take as many of them as you like.
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