Assistive Technology Survey
Thank you for agreeing to complete the following survey. Please fill out all answers as complete as you can. Completed survey respondents will be added to a draw for a FREE Google Mini. Draw will be made on June 14th at 4:00 pm.

Please Note: Email address is required for the draw only and will not be shared or used for any additional purposes.
Email address *
What types of Assistive Technology do you use? (Choose all that apply)
What is your age?
What is your household size?
What is the highest level of Education or Training you have completed?
What is your current level of employment?
If employed, does your employer supply the technology you need?
How often do you purchase Assistive Technology?
Are you able to do everything you'd like with your current Assistive Technology?
Do you receive funding for Assistive Technology purchases?
If you do or have received funding for Assistive Technology, who gave you the funding?
What piece of Assistive Technology do you need but don't currently own?
Your answer
What is the biggest hurdle(s) regarding Assistive Technology for you? (Choose all that apply)
How often do you use Assistive Technology on a daily basis?
What aspects are most important to you when purchasing Assistive Technology? (Choose all that apply)
What Social Media do you use on a regular basis? (Choose all that apply)
Are you active in any LinkedIn groups, Facebook groups, or online communities?
What are some of your hobbies or interests that could be enhanced with Assistive Technology?
Your answer
What environment do you require Assistive Technology for? (Choose all that apply)
What is your main source of information regarding Assistive Technologies that are available? (Choose all that apply)
What is your main source of information regarding funding for Assistive Technology that is available? (Choose all that apply)
What kind of online meeting software do you prefer?
What sort of support do you feel you need in relation to your particular disability?
Your answer
What technology skills do you feel you are lacking and would be interested in developing further?
Your answer
Would you be interested in a blind or low vision Mentor?
Are you interested in being a Mentor to a blind or low vision individual?
Would you be interested in Assistive Technology device training?
What kind of Assistive Technology training would you be interested in? (Choose all that apply)
What is your preferred learning style?
Would you travel to participate in Training or would you prefer in-home lessons?
What are the biggest challenges you face on a daily basis? (Choose all that apply)
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service