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* 1. Name

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* 2. Title/Occupation

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* 3. School/Agency

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* 4. Address

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* 5. Email

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* 6. Phone

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* 7. How many years of experience do you have in the field of education and/or the field of blindness/accessible technology?

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* 8. What age group is using the Envision I or Envision II kits?

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* 9. Who is providing instruction for the Envision Training Programs?

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* 10. In what setting is instruction taking place using the Envision I or Envision II kits?

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* 11. Which kit have you used?

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* 12. Have you used the Envision training program with magnifiers included in the kit?

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* 13. Have you used the Envision training program with telescopes included in the kit?

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* 14. How often do you use the instructional materials in the kit to teach the use of optical devices?

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* 15. How often do you use the magnifiers/telescopes in the kit for instruction?

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* 16. How often do you use optical devices that the student already has?

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* 17. Please indicate the need of each component for the Envision I Kit for Distance with Telescope Array.
APH Innovations Tote Bag

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* 18. Envision Carry-Case for Telescopes

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* 19. Content List/ Diagrams/ Suggested Uses Sheet (print and braille)

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* 20. Distance Card Pack
 

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* 21. Emmy the Emu Puppet

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* 22. Envision I and II Consumables Pack (Skills Performance Checklist)

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* 23. Envision I Ages 10 and Under Teacher's Manual

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* 24. Envision I Ages 11 and Older Teacher's Manual

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* 25. Selsi 2.5X Monocular Lens

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* 26. Lighthouse 4X Monocular Lens

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* 27. Lighthouse 6X Monocular Lens

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* 28. Specwell 8X Monocular Lens

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* 29. Specwell 10X Monocular Lens

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* 30. Please indicate the need of each component for the Envision II Kit for Near Magnification with Magnifier Array.
APH Innovations Tote Bag
  

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* 31. Emu Puppet
 

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* 32. Washable crayon Pack (16 Crayons)

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* 33. Envision I and II Consumables Pack (Skills Performance Checklist)

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* 34. Envision 2 Teacher's Manual, for Ages 10 and Under

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* 35. Envision 2 Teacher's Manual, for Ages 11 and Over

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* 36. Envision 2 Activities Binder, for Ages 10 and Under

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* 37. Envision 2 Activities Binder, for Ages 11 and Over

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* 38. Comic Book (5-Pack)

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* 39. Envision Carry-Case for Magnifiers

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* 40. Content List/ Diagrams/ Suggested Uses Sheet (print and braille)

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* 41. Lens Cleaning Cloth

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* 42. Eschenbach 1.8X Bright Field Magnifier

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* 43. Magni-Brite 4X Dome Magnifier

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* 44. Eschenbach 6X Magnifier

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* 45. Power Mag 6X LED Magnifier

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* 46. Eschenbach 8X illuminated Magnifier

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* 47. Power Mag 10.5X LED Magnifier

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* 48. How often do you use the Envision kits?

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* 49. How often does the student use their own classroom materials during the Envision training program?

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* 50. How often does the student use their own magnification and telescope devices during the Envision training program?

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* 51. Do you think APH should discontinue the way the kit is currently packed?

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* 52. What items would you add or remove from the Envision I or Envision II Kits?

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* 53. Would you like to see a low vision training program geared towards transition age students and adults?

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* 54. Would you use the current Envision kits with adults?

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* 55. Select the style of magnifiers and telescopes that would best suit the needs of transition students and adults learning the use of optical devices.

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* 56. Please indicate what items a kit should  include to help increase daily living skills and use of optical devices for low vision users.

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* 57. Please select which name would best convey the meaning of a kit targeted to transition and adults.

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* 58. Please leave any additional feedback here.

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