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Tech Access Initiative Volunteer Participation Inquiry
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1.
Please provide your contact information:
(Required.)
Name
City
State
ZIP Code
Email Address
Phone Number
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2.
United Spinal chapter affiliation:
(Required.)
3.
Please select: (optional)
I would like to subscribe to United Spinal's Tech Access communications and resource publications
I am interested in hearing more about and participating in United Spinal's Tech Access Initiative
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4.
Please select your level of injury (or the level of the person you are representing):
(Required.)
Paraplegic with leg function
Paraplegic without leg function
Quadriplegic with finger function
Quadriplegic without finger function
Quadriplegic with arm function
Quadriplegic without arm function
I do not have a mobility disability
Alternate diagnoses (please explain your functional mobility limitations):
5.
Mobility equipment usage: (check all that apply)
Manual wheelchair
Power wheelchair
Walking stick/cane/crutches
Mobility scooter
I do not require mobility equipment
Other (please specify)
6.
Please check the following items you use:
Smart phone
Laptop computer
Desktop computer
Tablet
Smart speaker(Amazon Alexa, Google Nest, Apple Homepod, etc.)
Wearable connectivity device
Environmental controls
Virtual reality device
Other personal tech usage: (please specify)
7.
Please list any assistive technology device that you utilize:
Eye tracking
Speech to text software
Screenreader
Mouth mouse
Proportional head control mouse
Switch control
Mouth sticks
Typing aides
Joystick controller
Adaptive video game controller
Remote health and safety monitoring device(s)
Internet connected mobility or healthcare device(s)
I do not require assistive technology
Other assistive technology device usage: (please specify)
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8.
As our Tech Access Initiative seeks to get individuals mobility disabilities involved as testers and authorities on their needs as customers, we are looking for diverse individuals with personal and technology industry insights.
Please tell us a bit more about yourself and your relationship with technology, including any specific training or professional technology related experience or perspective:
(Required.)
9.
Beyond personal computing and their related assisted technology devices, please list any other tech areas you are interested in or specific products you utilize (i.e. medical device technologies, mobility tech devices, web accessibility, artificial intelligence, autonomous vehicles, videogame accessibility, tech related policy etc.):
10.
In the future, United Spinal's Tech Access program will offer opportunities for members in the following areas, please check boxes for activities where you would like to participate (compensation for time and expense will vary):
Product research and design testing
Product testing and review blogging
Product testing and review video demonstration or video blog
Tech subject related blogging or article writing
Focus group
Clinical trial
Tech usage survey design
Tech usage survey participation
United Spinal representation at tech events local to your area
United Spinal representation at tech events that require travel beyond your local area
Corporate accessibility assessment
Adaptive technology training facilitator
Other ways you would like to contribute: (please specify)
Thank you for your time, and we look forward to working with you as we roll out this important initiative.
Current Progress,
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