Thanks.
Perhaps the "how" part was a bit buried in the attachments. Here's the
quick answer:
I've attached the questionairre to this note. You can also just ask to be
contacted.
How to reach the CTIB
E-mail: techctr at afb.net
Tel: (212) 502-7642
Fax: (212) 502-7773
Website: www.afb.org -- Search for "CTIB"
CTIB
American Foundation for the Blind
11 Penn Plaza, Suite 300
New York, NY 10001
On Tue, 12 Mar 2002, A. R. Vener wrote:
> Sure. How?
> rudy
>
--
Janina Sajka, Director
Technology Research and Development
Governmental Relations Group
American Foundation for the Blind (AFB)
Email: janina at afb.net Phone: (202) 408-8175
Chair, Accessibility SIG
Open Electronic Book Forum (OEBF)
http://www.openebook.org
-------------- next part --------------
Careers and Technology Information Bank Questionnaire
(This form cannot be filled out on-line at this time. You can either download the form or you can call 212-502-7642 to be interviewed by telephone)
GENERAL INFORMATION
1. Name:
2. title: (Mr. Ms.)
3. Street Address:
4. City:
5. State/Province:
6. Postal code:
7. Country:
8. Home phone:
9. Work Phone:
Extension:
10. E-mail:
10a. Second e-mail:
11. Which describes your vision best at this time?
1. No visual problem (Thank and end interview.)
2. No useful vision
3. little useful vision
4. some useful vision
5. considerable useful vision
12. At what age was your visual impairment first observed?
13. Please briefly describe any other impairment or health problem which might affect your ability to work.
1. None
2. Motion impairment involving your fingers, hands or arms.
3. Learning disability
4. Other
EDUCATIONAL BACKGROUND
14. Are you currently a student?
1. Yes
2. No
15. What is the highest level of education you have completed?
1. Grade school
2. Some high school
3. High school graduate
4. Some college
5. College graduate
6. Some post graduate study
7. Post graduate degree
16. Please list any certificates, licenses, registrations, or degrees you have acquired:
17. Please choose from the list below any additional schooling or training you have completed by marking all that apply with an "x" following the item
listed.
1. a miscellaneous coursework at a school or college
2. a certificate program
3. a two-year degree program
4. block time program in a craft or trade
5. a trade or technical school program
6. a union apprenticeship
7. an internship (paid)
8. a volunteer trainee position (unpaid internship)
9. in-service training at your place of work
10. special courses sponsored by an employer away from workplace
JOB INFORMATION
18. Are you currently employed?
1. Yes
2. No (Skip to q32.)
19. Do you work for yourself or for others?
If for others, skip to Q21.
a. Self
b. Others
20. What product or service do you provide?
Please complete the following questions for primary and secondary jobs as indicated (a for primary; b for secondary).
21. a) Do you work full-time or part-time?
b) Do you work full-time or part-time?
22. a) Give the number of work hours per week you usually work:
b) Give the number of work hours per week you usually work:
23. Are you satisfied with the number of hours you are working?
(a) 1. Yes
2. No, too few hours
3. No, too many hours
(b) 1. Yes
2. No, too few hours
3. No, too many hours
24. a) What is your job title?
b) What is your job title?
25. a) What is your company's name?
b) What is your company's name?
26. a) If your job is also known by some other title, please give it:
b) If your job is also known by some other title, please give it:
27. a) Please list the major tasks you perform and skills you use on your job:
b) Please list the major tasks you perform and skills you use on your job:
28. a) How long have you held this job?
b) How long have you held this job?
29. a) What is the salary range for this job?
b) What is the salary range for this job?
30. a) What benefits are provided to you in this job?
b) What benefits are provided to you in this job?
31. a) Did you secure this job before or after you became visually impaired?
b) Did you secure this job before or after you became visually impaired?
JOB ACCOMMODATION/TECHNOLOGY
32. What products do you use related to visual impairment? Please list: computer hardware, software and peripherals, reading aids, talking products
and optical character recognition products. List each product name, version number (where applicable) and manufacturer.
32A. Do you currently use a cellular phone or pager?
a. Yes, (please list the product name and manufacturer.)
b. No.
33. Have you received any training on the products that you use?
1. Yes
2. No
34. Which organizations provided your training?
35. Who paid for the equipment you are currently using on your job?
1. The interviewee
2. The employer
3. A state agency for the blind
4. Other (specify)
36. Please describe any job accommodations you use on your job:
37. Was the request for these accommodations initiated by:
a. you
b. your counselor
c. your employer
d. all of the above
e. none of the above (please provide details)
FORMER JOBS
38. What other jobs, if any, have you performed for your present employer, former employers or in self-employment? (List up to three jobs.)
OTHER PERSONAL INFORMATION
39. What is your birth date?
40. (enter person's gender)
41. Are you willing to be contacted by AFB or other visually impaired people about the products you use or your job experience?
1. Yes
2. Yes, including as a mentor for students
3. No (skip to Q45.)
4. Only by AFB as a product tester and participant in technology-related surveys.
5. As both a mentor and a product tester/ survey participant.
42. In what format would you prefer to receive mailings from us?
a. Large Print
b. Braille
c. 3.25 inch IBM diskette
d. e-mail
43. How would you prefer to be contacted?
1. Work phone
2. Home phone
3. Letter (skip to Q46.)
4. e-mail
44. What is the best local time to reach you?
45. Since you prefer not being contacted, may we use the information you've given us for statistical purposes without your name being associated with
it?
1. Yes
2. No
46. How did you find out about our Careers and Technology Information Bank?
47. Do you know any other visually impaired workers who might be willing to provide information about their jobs through involvement in the CTIB?
48. Thank you very much. If you have any questions, suggestions, or concerns about this project, please contact us at [9]techctr at afb.net.
49. Today's Date:
______________________________________________________________________________________________________________________________________________________
Published: 09/27/00
For more information please contact American Foundation for the Blind,
via e-mail: [10]afbinfo at afb.net
Or use traditional mail services:
American Foundation for the Blind
11 Penn Plaza
Suite 300
New York, NY, 10001, USA
