Your State * Select One * Other (please select your country) Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming
If you are an Ohio resident, please indicate your county Not an Ohio resident Adams Allen Ashland Ashtabula Athens Auglaize Belmont Brown Butler Carroll Champaign Clark Clermont Clinton Columbiana Coshocton Crawford Cuyahoga Darke Defiance Delaware Erie Fairfield Fayette Franklin Fulton Gallia Geauga Greene Guernsey Hamilton Hancock Hardin Harrison Henry Highland Hocking Holmes Huron Jackson Jefferson Knox Lake Lawrence Licking Logan Lorain Lucas Madison Mahoning Marion Medina Meigs Mercer Miami Monroe Montgomery Morgan Morrow Muskingum Noble Ottawa Paulding Perry Pickaway Pike Portage Preble Putnam Richland Ross Sandusky Scioto Seneca Shelby Stark Summit Trumbull Tuscarawas Union Van Wert Vinton Warren Washington Wayne Williams Wood Wyandot
If you are an Ohio resident and associated with a school district, please indicate your district Select a county first
Your Country * United States Canada United Kingdom Ireland Australia New Zealand Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, The Democratic Republic of The Cook Islands Costa Rica Cote D'ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-bissau Guyana Haiti Heard Island and Mcdonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia, The Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and The Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and The South Sandwich Islands Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Timor-leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe
Your Position * Select One Administrative - CEO / Executive Director / Director Administrative - Curriculum Director Administrative - Early Childhood Administrative - Early Intervention Administrative - Higher Education Administrative - Principal Administrative - Special Education Director / Coordinator Administrative - Pupil Personnel Director / Coordinator Administrative - Superintendent Administrative - Other Adult Services - Adult Day Program Provider Adult Services - Adult Residential Provider Adult Services - Service and Support Administrator Adult Services - Job Coach Adult Services - Vocational Rehabilitation Counselor Adult Services - Vocational Services Provider Adult Services - Other Business - Sales Business - Public Relations / Marketing Business - Other Early Childhood - Head Start Early Childhood - Preschool Early Childhood - Other Early Intervention - Early Intervention Specialist Early Intervention - Service Coordinator Early Intervention - Other K-12 Education - General Education K-12 Education - Paraprofessional / Instructional Assistant K-12 Education - Special Education / Intervention Specialist K-12 Education - Student K-12 Education - TOD - Teacher of the Deaf K-12 Education - Transition Specialist / Coordinator K-12 Education - TVI - Teacher of Students with Visual Impairments K-12 Education - Other Families - Family Member Families - Parent Families - Other Health Care - Nurse Health Care - Pediatrician Health Care - Physician Health Care - Other Higher Education - Instructor Higher Education - Professor Higher Education - Researcher Higher Education - Undergraduate / Graduate Student Higher Education - Other Individual with Disability Related Services - Assistive Technology Specialist Related Services - Audiologist Related Services - Behavior Specialist / Therapist Related Services - COMS - Certified Orientation and Mobility Specialist Related Services - Interpreter Related Services - Mental Health Provider Related Services - Occupational Therapist Related Services - Parent Advocate Related Services - Parent Mentor Related Services - Physical Therapist Related Services - Psychologist Related Services - Speech-Language Pathologist Related Services - Social Worker Related Services - Support Staff Related Services - Technology Specialist Related Services - Transcriber Related Services - Other
Years of experience working or living with individuals with disabilities * Select One 0-5 5-10 10-15 Over 15 No experience
Age range of the individual or students with disabilities with which you currently live or work * Select One 0-5 6-12 13-21 Over 21 All Ages Multiple Ages
What is your current level of knowledge about assistive technologies? * Select One No knowledge Limited knowledge Moderate knowledge Very knowledgeable Instructs others on AT
I have participated in ___ hours of coursework, staff development or training related to assistive technology in the last 2 years * Select One 0 hours 1-10 hours 11-20 hours 21-40 hours More than 40 hours
Your Gender (Optional) Select One Male Female
Your Race (Optional) Select One American Indian or Alaska Native Asian Black or African American Hispanic / Latino Multi-Racial Native Hawaiian or Other Pacific Islander White
Prior coursework, staff development, or trainings on assistive technology topics have been in which of the following formats? (select all that apply)
Local Inservice Training
Local Conferences
State Conferences
National Conferences
College Courses
Certificate Program in AT
Degree Program in AT
On-line Learning