The American Printing House for the Blind (APH) regularly conducts field tests of new products that are under development. APH uses the comments and recommendations gathered from experts in the field to refine and improve products before actual production. If you would like to be considered for future field test opportunities, please complete and submit this form.

NOTE : The questions on this form are in reference to the individual (e.g., TVI) completing the form.

* 1. Field Tester Classification (check all that apply):

* 2. Primary Contact Information 
For professionals in the field only, the job title/description and school/agency fields are required.

* 3. Please list any professional certifications and degrees you may have. Use N/A if not applicable.

* 4. Secondary Contact Information

* 5. Which categories of students or clients/consumers do you work with? Check all that apply.

* 6. In a typical year, what is your caseload?

* 7. Your visual function:

* 8. Your preferred reading medium:

* 9. Your ethnicity/race:

* 10. Your age range:

* 11. Your areas of interest/expertise (check all that apply):

* 12. Are you available for field-testing activities during the months of June, July, and/or August?

* 13. Who was your initial APH contact?

* 14. Where or at what event were you initially contacted?

* 15. Have you conducted field testing for APH in the past?

* 16. Is there a particular product that you would like to test or feel especially qualified to test? Please explain why.