EXIT Tech Access Initiative Volunteer Participation Inquiry Question Title * 1. Please provide your contact information: Name City State ZIP Code Email Address Phone Number Done Question Title * 2. United Spinal chapter affiliation: Done Question Title * 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 Done Question Title * 4. Please select your level of injury (or the level of the person you are representing): 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): Done Question Title * 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) Done Question Title * 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) Done Question Title * 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) Done Question Title * 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: Done Question Title * 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.): Done Question Title * 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) Done Thank you for your time, and we look forward to working with you as we roll out this important initiative. Done DONE
