Geometric Drawing Stencils Field-Tester Application Form Question Title * 1. Your name Question Title * 2. What is your professional title (TVI, O&M specialist, math teacher, etc.)? Question Title * 3. Type of program/instruction setting (e.g., residential school, itinerant, resource room) Question Title * 4. Years of experience teaching students with visual impairments Question Title * 5. How many students who are blind will be available to participate in this field test during the Fall 2023 semester? We expect you to test this product with students who primarily create and use tactile graphics instead of print graphics in their math studies. Question Title * 6. Will your students be able to use their own rubber mats or rubber-covered drawing boards, such as APH’s DRAFTSMAN Drawing Board or TactileDoodle, during this field test? Yes No Please explain. Question Title * 7. Your contact information: Name * Agency * Address * Address 2 City/Town * State/Province * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code * Country Email Address * Phone Number * Question Title * 8. Do you have additional information you would like to share regarding your potential participation in this field test? Done