Envision Kit I and II Needs Survey Question Title * 1. Name OK Question Title * 2. Title/Occupation OK Question Title * 3. School/Agency OK Question Title * 4. Address City/Town State/Province Zip/Postal Code OK Question Title * 5. Email OK Question Title * 6. Phone OK Question Title * 7. How many years of experience do you have in the field of education and/or the field of blindness/accessible technology? 0-5 6-10 11-15 16-20 21+ OK Question Title * 8. What age group is using the Envision I or Envision II kits? Students 10 and Younger Students 11 and Older Transition Age Students Adults Seniors OK Question Title * 9. Who is providing instruction for the Envision Training Programs? TVI CVRT CLVT O&M OT OD Physician Other OK Question Title * 10. In what setting is instruction taking place using the Envision I or Envision II kits? Classroom Work Home Orientation and Mobility Resource Center Blind Rehabilitation Center Vocational Rehabilitation Center Low Vision Clinic VA Other OK Question Title * 11. Which kit have you used? Envision I Envision II Both Neither OK Question Title * 12. Have you used the Envision training program with magnifiers included in the kit? Yes No Used other devices OK Question Title * 13. Have you used the Envision training program with telescopes included in the kit? Yes No Used other devices OK Question Title * 14. How often do you use the instructional materials in the kit to teach the use of optical devices? Often Sometimes Rarely Never OK Question Title * 15. How often do you use the magnifiers/telescopes in the kit for instruction? Often Sometimes Rarely Never OK Question Title * 16. How often do you use optical devices that the student already has? Often Sometimes Rarely Never OK Question Title * 17. Please indicate the need of each component for the Envision I Kit for Distance with Telescope Array.APH Innovations Tote Bag Needed Not needed OK Question Title * 18. Envision Carry-Case for Telescopes Needed Not Needed OK Question Title * 19. Content List/ Diagrams/ Suggested Uses Sheet (print and braille) Needed Not Needed OK Question Title * 20. Distance Card Pack Needed Not needed OK Question Title * 21. Emmy the Emu Puppet Needed Not needed OK Question Title * 22. Envision I and II Consumables Pack (Skills Performance Checklist) Needed Not needed OK Question Title * 23. Envision I Ages 10 and Under Teacher's Manual Needed Not needed OK Question Title * 24. Envision I Ages 11 and Older Teacher's Manual Needed Not needed OK Question Title * 25. Selsi 2.5X Monocular Lens Needed Not needed OK Question Title * 26. Lighthouse 4X Monocular Lens Needed Not needed OK Question Title * 27. Lighthouse 6X Monocular Lens Needed Not needed OK Question Title * 28. Specwell 8X Monocular Lens Needed Not needed OK Question Title * 29. Specwell 10X Monocular Lens Needed Not needed OK Question Title * 30. Please indicate the need of each component for the Envision II Kit for Near Magnification with Magnifier Array.APH Innovations Tote Bag Needed Not needed OK Question Title * 31. Emu Puppet Needed Not needed OK Question Title * 32. Washable crayon Pack (16 Crayons) Needed Not needed OK Question Title * 33. Envision I and II Consumables Pack (Skills Performance Checklist) Needed Not needed OK Question Title * 34. Envision 2 Teacher's Manual, for Ages 10 and Under Needed Not needed OK Question Title * 35. Envision 2 Teacher's Manual, for Ages 11 and Over Needed Not needed OK Question Title * 36. Envision 2 Activities Binder, for Ages 10 and Under Needed Not needed OK Question Title * 37. Envision 2 Activities Binder, for Ages 11 and Over Needed Not needed OK Question Title * 38. Comic Book (5-Pack) Needed Not needed OK Question Title * 39. Envision Carry-Case for Magnifiers Needed Not needed OK Question Title * 40. Content List/ Diagrams/ Suggested Uses Sheet (print and braille) Needed Not Needed OK Question Title * 41. Lens Cleaning Cloth Needed Not needed OK Question Title * 42. Eschenbach 1.8X Bright Field Magnifier Needed Not neded OK Question Title * 43. Magni-Brite 4X Dome Magnifier Needed Not neded OK Question Title * 44. Eschenbach 6X Magnifier Needed Not needed OK Question Title * 45. Power Mag 6X LED Magnifier Needed Not needed OK Question Title * 46. Eschenbach 8X illuminated Magnifier Needed Not needed OK Question Title * 47. Power Mag 10.5X LED Magnifier Needed Not needed OK Question Title * 48. How often do you use the Envision kits? Often Sometimes Rarely Never OK Question Title * 49. How often does the student use their own classroom materials during the Envision training program? For all tasks For some tasks For none of the tasks Use what is provided in the kit OK Question Title * 50. How often does the student use their own magnification and telescope devices during the Envision training program? For all tasks For some tasks For none of the tasks Use what is provided in the kit OK Question Title * 51. Do the magnifiers and telescopes need to be updated in the Envision Training Programs? Yes No OK Question Title * 52. Do you think APH should discontinue the way the kit is currently packed? Yes No Unfamiliar with kit Comment OK Question Title * 53. What items would you add or remove from the Envision I or Envision II Kits? OK Question Title * 54. Would you like to see a low vision training program geared towards transition age students and adults? Yes No If not, please explain why. OK Question Title * 55. Would you use the current Envision kits with adults? Yes No OK Question Title * 56. Select the style of magnifiers and telescopes that would best suit the needs of transition students and adults learning the use of optical devices. Stand magnifier Handheld magnifier Illuminated magnifier Non-illuminated magnifier LED magnifier Pocket magnifier Pendent magnifier Dome magnifier Head-borne Handheld video magnifier Wearable telescope Binoculars Electronic monocular Large monocular with high power and smaller view Small monocular with less power and wider view Other OK Question Title * 57. Please indicate what items a kit should include to help increase daily living skills and use of optical devices for low vision users. OK Question Title * 58. Please select which name would best convey the meaning of a kit targeted to transition and adults. Low Vision Kit Transition Kit Daily Living Kit Innovations Kit Envision Transition Kit Envision III Kit Other OK Question Title * 59. Please leave any additional feedback here. OK DONE