*1.Field Evaluator Information(Required.)

Name

Title/Position

School or Agency

Address 

City 

State

ZIP Code

Email Address

Phone Number

*2.In what type of setting do you work?(Required.)

Residential

Itinerant

*3.Please select the category(ies) of participants who will be using or evaluating the Transforming Braille Display. Check all that apply.(Required.)

Elementary students who are braille readers

Braille students who are reading below grade level

Braille students who have a mild cognitive disability

Teachers of the Visually Impaired

School libraries that provide braille materials for patrons

Home settings – Parents and young students

Other (please specify)

*4.Please select your first choice for Field Evaluation dates.(Required.)

November 16–December 4

December 7–18

January 4–15

*5.Please select your second choice for Field Evaluation dates.(Required.)

November 16–December 4

December 7–18

January 4–15