Multiple Sclerosis Foundation - Assistive Technology Program

The Assistive Technology (AT) Program may help locate, partially fund, or provide full funding for one of a wide range of devices. These allow those with MS to function more independently in their daily lives, as well as more easily participate in recreational, educational, and vocational activities. These include:

Aids for daily living
Communication devices
Computer aids
Environmental control systems
Home and vehicle modifications
Orthotics
Seating, positioning, and mobility devices
Aids for vision and hearing
Cooling aids

Print Application Online Application

Date of Birth (mm/dd/yyyy):

When were you diagnosed with MS?(mm/dd/yyyy):

Now

Current Major Symptoms:

May we leave a detailed message about this application on your voice mail or with another household member, if you are not available?:

Do you or your spouse have Medical Insurance?:

MedicareMedicaidPrivate Carrier

What type of equipment do you have now?:

What additional equipment do you need?:

Are you employed?:

Yes
No

Spouse employed?:

Yes
No

Monthly Gross Income (Less Witholding Taxes)

Monthly Expenses

Mortgage or Rent:

Enter security code: