Apply for Services

You should apply with TAP-I for services first. If denied, then you may apply for services with TAVI-MO.

Part 1: Personal Information

Part 2: Equipment Selection

Part 3: Disability Certification

(To be completed by a licensed physician, speech pathologist, audiologist, hearing instrument specialist or a Missouri Assistive Technology approved agency representative.) Please use the printable form from the PDF version of this document.

Part 4: Applicant Signature and Information Release

The above facts are true and complete to the best of my knowledge. Upon request, I will provide verification of the information provided. I authorize TAVIM for Internet to release my name, address, and phone number to a consumer support provider.