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This application will help us identify potential participants for the consideration of adaptive gaming technology.  This project is grant funded.  The goal of the project is  to help individuals with disabilities in Rhode Island increase their access to gaming. Information gained from the application will be used to help us provide the most appropriate equipment and support services to participants in the project. All of your information will be kept confidential.  

We will be providing participants with a 3-month loan of technology that can increase their access to gaming. The purpose of the loan period is to determine what specific gaming technology best fits individual participant’s needs and abilities. At the conclusion of the loan period, we will also help identify potential funding sources to assist in acquiring the equipment that has been identified.  

Please answer the following questions so we may determine if you qualify for assistive technology through this project. 

We very much appreciate your interest and your time in completing this application.  We will contact you to discuss your participation once we have reviewed the application.

Thank you! 

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* 1. Are you currently a resident of Rhode Island?

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* 2. Please provide the information below.

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* 3. What gaming system do you own?

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* 4. Is there a different system you would like to play?

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* 5. Please list what games you are interested in playing.

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* 6. What are currently some of your strengths and challenges around accessing your gaming system?

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* 7. Are you currently using any adaptive gaming equipment?

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* 8. What is your disability? 

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* 9. Do you have access to the internet in your home?

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* 10. Are you comfortable meeting in small groups with others who are interested in adaptive gaming?

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* 11. Please provide any additional comments.

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* 12. Were you referred by anyone?

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