<p>Reused and Exchanged Equipment Partnership REEP Network Application Form – Please PRINT, COMPLETE & FAX</p><p>Applicant Information</p><p>First name ______</p><p>Last name______</p><p>Title______</p><p>Program Name______</p><p>Address 1______</p><p>Address 2______</p><p>City______State______Zip______</p><p>County______</p><p>Telephone______</p><p>Email address______</p><p>Program Website______</p><p>Identify area(s) you serve (check all that apply):  Town/City</p><p> County</p><p> Statewide</p><p> National</p><p>If multiple towns/cities or counties, please list: ______</p><p>______</p><p>Select the category of reuse that best describes your program (check all that apply):  Device exchange (matching donors to users without intervention, e.g., "classifieds" or online auctions)</p><p> Device reassignment (making donated devices available to new users)</p><p> Device recycling (breaking down unusable devices into spare parts or disposing of components in an environmentally appropriate manner)</p><p> Device refurbishing (repairing and/or restoring donated devices to working order)</p><p>Please fax your registration form to Jamie A. Prioli, RESNA ATP EMAIL: [email protected] FAX: 215-204-6336 Or mail to REEP Network Institute on Disabilities at Temple University 1755 N 13th Street / Student Center, Room 411S Philadelphia, PA 19122</p><p>Reused and Exchanged Equipment Partnership Network</p><p>Are you a reuse program? TAKE OUR SURVEY NOW! www.surveymonkey.com/s/REEPPartners</p><p>Pennsylvania’s Initiative on Assistive Technology–PIAT Institute on Disabilities at Temple University, College of Education</p>