Audiojack Survey

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* 1. Please provide your contact information in the event we would like to follow-up with you.

Name *

Company / Organization / School District *

Title *

Address

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number

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* 2. Please describe the type of organization you work for

Age range of Students or Clients typically served

Way in which services are provided (center-based, itinerant, home-based, residential school, resource room, other)

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* 3. Please list the Audiojack(s) you listened to.

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* 4. Please check the Activity you used with the Audiojack. Check all that apply.

Movie Poster

Split Story

Storyboard

The Mirror

The Story

I did my own activity

I didn't complete an activity

Please list any comments you have concerning Audiojack and accompanying Activity here

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* 5. Do you feel there is a need for this type of instruction for students who are blind or visually impaired?

This is a great instructional tool for students who are blind

I don't have an opinion one way or the other.

I don't feel there is a need for this.

This is a great instructional tool for students who are blind

I don't have an opinion one way or the other.

I don't feel there is a need for this.

Please share any comments about the need for this type of instructional tool here.

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* 6. Did you have a student or client use Audiojack?

Yes

If Yes, please list the Audiojack and any Activity that were used.

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* 7. Please list basic demographic information about the student or client who used it:

NA - Please indicate NA if you did not have a student or client use this.

Age

Grade Level (if in school)

Approximate functional visual acuity

Yes or No, does the individual have additional disabilities?

Any other information you feel is pertinent

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* 8. What were your student's reactions to using Audiojack?

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* 9. Because APH is interested in how this product can benefit individuals with visual impairments, please share how you feel Audiojack and the supporting Activities would benefit the learning of someone with a visual impairment.

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* 10. How would you as a professional who instructs individuals who are visually impaired incorporate Audiojack into your instruction?

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* 11. Do you think an Audiojack(s) and the supporting Activities should be developed specifically for individuals who are visually impaired?

Yes

If you answered yes, please share your thoughts on what the Audiojack or Audiojacks and supporting activities might be.

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* 12. What age range or grade range do you feel Audiojack is appropriate for?

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* 13. If you provide Orientation and Mobility services, do you feel an Audiojack of various traffic or common outdoor sounds would be beneficial as a pre-teaching tool to use before your students experienced real traffic sounds, traffic movement, or outdoor sounds encountered on an actual lesson? Why or why not? Please be as specific as possible.

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* 14. Please share any other thoughts or opinions you have concerning Audiojack and the accompanying Activities.

Thank you taking time to download Audiojack and provide APH with the information you supplied. Your time and thoughts are very much appreciated!!