Apply for Services

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

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Part 1: Personal Information

The following are requirements for requesting adaptive computer equipment through the TAVIM program. If you cannot answer “yes” to all of the following, contact the TAVIM program to discuss a possible referral.

Part 2: Equipment Selection

You will be contacted upon the receipt of this completed and signed TAVIM application form. To assist us in determining the level of support needed during the equipment selection process, please mark all of the following that apply to you.

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.