Description: This fillable ADRC Assistive Technology (AT) Screen is used by Alaska ADRC staff to determine if program participants are eligible to be referred to Assistive Technology of Alaska (ATLA) to obtain assistive technology. Screening questions include determining if technology could help the individual address a barrier to daily living, describing how ADRC staff and the participant believe AT could enhance the individual’s life, and indicating main reason(s) why the participant is being referred for AT. ADRC staff may provide additional notes for ATLA regarding the participant’s request for AT at the bottom of the form.