Graphiti Field Evaluator Application Question Title * 1. Address Name Job Title/Occupation School/Agency School/Agency City/Town State/Province ZIP/Postal Code Email Address Phone Number OK Question Title * 2. Your ethnicity/race Hispanic of any race American Indian or Alaskan Native Asian Black or African American Native Hawaiian or other Pacific Islander White Two or more races OK Question Title * 3. How many years of experience do you have in the field of education and/or blindness/accessible technology? 0-5 6-10 11-15 16-20 21+ OK Question Title * 4. What is your preferred reading medium? Print Large Print Braille Electronic OK Question Title * 5. Which categories of students or clients/consumers do you work with? Check all that apply. Elementary School Middle School High School Adults OK Question Title * 6. How many students or clients/consumers do you have that will be able to use the Graphiti? OK Question Title * 7. What is the instructional setting of your students or clients/consumers? Check all that apply. Residential School Itinerant – Public School Other – please list OK Question Title * 8. I agree to sign a Nondisclosure Agreement with Orbit Research. Yes No OK DONE