2018 Pearson User Study: Recruitment Questionnaire for Students Under the Age of 18

The study will be held at the National Federation of the Blind 2018 National Convention

Please complete the following items about your child. This will help us determine if she/he is a good match for this study.

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* 1. Please indicate the grade level of your child for the upcoming 2018-2019 school year:

6th

7th

8th

9th

10th

11th

12th

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* 2. Does your child have an identified or documented visual impairment? (This could include a designation in a Section 504 Plan, an IEP under IDEA, or other primary diagnosis as having a visual impairment, including such conditions as blindness or low vision).

Yes

No

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* 3. How would you best describe your child's visual impairment?

Blind

Low Vision

Combination of blind and low vision that is dependent on the environment, context, or circumstances. Please explain below.

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* 4. Has your child been identified as an English Language Learner (ELL or ESL)?

Yes

No

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* 5. Does your child have any of the following conditions: severe hearing impairment, cognitive or intellectual disability, or a severe motor impairment?

Yes

No

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* 6. Does your child use Nemeth braille for math and/or science coursework?

Yes

No

Unsure

Not applicable - my child is not a braille reader

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* 7. Does your child use a refreshable braille display together with a screen reader (for example, JAWS, NVDA, Window-Eyes or VoiceOver) while reading or writing materials on a computer?

Yes

No

Unsure

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* 8. Is your child comfortable sharing his or her opinion while being recorded?

Yes

No