Needs and Experiences of People with Physical Challenges
Thanks for participating in this online questionnaire.
Please note, that the questions of this survey are supposed to be answered only by people with ANY physical challenges (Cerebral Palsy - CP, ALS, SCI - of course, with the help of their caregivers if needed).
If you are a caregiver of a person with any physical challenge, or you work in a center or hospital supporting people with physical challenges or simply know someone who has a physical challenge, please share this survey with them! Thank you!
The purpose of this survey is to understand the needs and experiences of people with ANY physical challenges in regards with the devices they use and want to have as well as accompanying digital tools.
Results from this survey might be used as part of a bigger project led by Hackaday Dream team UCPLA challenge 2020:
The results from this survey might be used and presented publicly on the webpage of the project.
Upon completion, you can enter your email address if you wish to be selected for an opportunity to win one of 20 $15 Amazon Gift Cards. The winners will be selected randomly.
All the gift cards will be sent to the emails provided no later than August 31, 2020.
Please note that:
1. Your participation is voluntary.
2. Some questions are mandatory. However, if you do not want to answer them, you can exit the survey.
3. At any time, you may decline further participation without adverse consequences. To do this, simply close the survey without submitting your answers.
4. Your confidentiality and anonymity are assured. We will not collect any personally identifying information (e.g. your name or contact information).
If you want to learn more about the project and/or have any additional questions or want to share your experiences - please do not hesitate to contact us at nkosmyna AT mit DOT edu.
For more information about this project and the team members please visit:
Do you consent to participate?
If you do not, you can exit the survey now.
I understand and consent to the terms of participation for this survey.
Please confirm that you are not a caregiver (or in case, when you are a caregiver who is helping with the survey form), you are willing to fill out this survey with respect to the REAL and ACTUAL needs of the person you are taking care of.
Yes, I understand that this survey is not intended to collect the data about the caregivers' needs. I confirm that I will be only helping to fill this survey out and not projecting my feelings, ideas and suggestions.
Page 1 of 11
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service