NAPVI Survey

A request from Susan LaVenture, Executive Director of NAPVI: The National Association for Parents of Children with Visual Impairments (NAPVI) and the American Foundation for the Blind (AFB) are exploring the idea of creating a web site for parents so that you can have vital information available for you as you are raising your child who is visually impaired into adulthood. We need to know if you have access to the Internet and if you would actually be interested in using our web site for parents as a resource and what other ways you prefer to receive information. If you prefer to complete the survey by phone or want to receive a Braille or Spanish-language version by mail, please call: 1-800-562-6265. Thank you in advance for your valuable input! First, tell us a little about your visually impaired child. How old is your child? Child's age Less than 1 year 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years 16 years 17 years 18 years 19 years 20 years 21 years At what age was your child first diagnosed with a visual impairment? Child's age when first diagnosed Less than 1 year 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years 16 years 17 years 18 years 19 years 20 years 21 years Next, we will ask about where you look for information regarding your child's needs. Which of the following sources do you currently use to get medical/health, educational, recreational, or social support information regarding your child? Physicians or other health professionals Friends or family members Other parents Local blindness or low vision agencies Teachers/other educational professionals Print publications (newsletters, etc.) Television or radio Telephone hotlines Web sites Other (Please specify below.) If you selected "Other" please specify here. Now, we will ask about your own personal Internet activity (not your child's). Do you use the Internet, at least occasionally? If no, skip to Question #10. "What is the primary language spoken in your home?" Select Yes or No Yes No Where do you access the Internet? From home At my workplace Other (for example, public library, church, school, friend's) If you are selecting "Other" please specify below. If you selected "Other" please specify. When going online to seek information about visual impairment, which of the following types of information have you looked for: Health or medical Educational Recreational/entertainment Social and life skills Career/employment opportunities What web sites have you found most useful regarding visual impairment? Finally, we'd like to ask you a few questions about yourself that are for analysis only, in order to help us determine whether families from different backgrounds have access to the Internet. Please be assured that this information will remain confidential. What is the primary language spoken in your home? Which of the following best describes your race or ethnicity? Asian Black or African American Hispanic or Latino White Other (If selecting "Other" please specify below.) If you selected "Other" please specify. Which of the following broad categories best describe your yearly household income? Choose one for household income. Less than $20,000/year $20,000 – $39,999 $40,000 – $74,999 $75,000 or more What is the state where you live? Choose the state that you live in. Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming What is the zip code where you live? If you are willing to participate in further interviews or focus groups to help in the design of a web site, please give us your contact information below: If you are willing to participate in further interviews or focus groups to help in the design of a web site, please give us your contact information below: Name: Address: (Include City, State, and Zip Code.) Telephone: (Include area code.) E-mail: