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?

At what age was your child first diagnosed with a visual impairment?

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?"

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:

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?

If you selected "Other" please specify.

Which of the following broad categories best describe your yearly household income?

What is the state where you live?

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: