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2019 Pearson Tactile Graphic Study: Recruitment Questionnaire
The study will be held at the National Federation of the Blind 2019 National Convention
Please complete the following items.. This will help us determine if you or your child is a good match for this study.
1.
Please indicate your grade level (or the grade level of your child) for the upcoming 2019-2020 school year:
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Other (please specify)
2.
Do you (or your child) have an identified or documented visual impairment? (This could include a designation in a Section 504 Plan, an IEP under IDEA, or other primary diagnoses as having a visual impairment, including such conditions as blindness or low vision).
Yes
No
3.
How would you best describe your (or your child's) visual impairment?
Blind
Low Vision
Combination of blind and low vision that is dependent on the environment, context, or circumstances. Please explain below.
4.
Are you (or has your child been) identified as an English Language Learner (ELL or ESL)?
Yes
No
5.
Do you (or does your child) have any of the following conditions: severe hearing impairment, cognitive or intellectual disability, or a severe motor impairment?
Yes
No
6.
Do you (or does your child) read braille or a combination of print and braille?
Yes
No
Other (please specify)
7.
Are you (or Is your child) on grade level in math and science?
Yes, on or above grade level in math and science
No, 1-2 grade levels below in math and science
No, 3 or more grade levels below in math and science
Unsure
8.
Are you (Is your child) on grade level in ELA and social studies?
Yes, on or above grade level in ELA and social studies
No, 1-2 grade levels below in ELA and social studies
No, 3 or more grade levels below in ELA and social studies
Unsure
9.
Are you (Is your child) comfortable sharing his or her opinion while being recorded?
Yes
No
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