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. .Do you have a disability? ?
 
Yes
 
No
 
 
 
How often do you conduct surveys?
 
Weekly
 
Monthly
 
Quarterly
 
Annually
 
Other
 
 
 
 
2. If you answered No in the previous question. what is your relationship with the person with special needs?
 
Paren
 
Tbrother
 
Friend
 
Instructor
 
Other (please specify)
 
 
 
3. age :
 
1-5
 
5-10
 
10-15
 
15-20
 
20-25
 
more than 25
 
 
 
4. Gender:
 
Male
 
Female
 
 
 
5. What kind of disability do you have?
 
Physical disability
 
Visual disability
 
Intellectual disability
 
Learning disability
 
Legally Blind
 
Autism Spectrum Disorder (ASD)
 
Attention Deficit Disorder (ADD)
 
Obsessive Compulsive Disorder (OCD)
 
Deaf
 
Brain Injury
 
Hard of Hearing
 
)
 
Other
 

 
 
 
How often do you conduct surveys?
 
Weekly
 
Monthly
 
Quarterly
 
Annually
 
 
 
6. Did the assistive technology helped you?
 
Yes
 
No
 
 
 
7. What is the purpose of using assistive technology?
 
Working
 
Learning
 
Living requirement(walking,hearing,etc)
 
social requirement(communicating,making friends,etc)
 
Other
 
 
 
 
8. What kind of assistive technology product do you use?
 
Screen Readers (Jaws ,Window-Eyes ,outSpoken (Mac) ,etc)
 
Screen Magnification Software(• Zoomtext ,Magic ,etc)
 
OCR/Reading Solutions(Kurzweil 3000,Kurzweil 1000,OpenBook,etc)
 
speech recognition applications(Dragon Naturally Speaking,Dragon Dictate,etc)
 
Hands-free speech-free input devices(HeadMouse,HeadMaster,etc)
 
Other