RESNA SIG-11 Membership Resource Form

                  Membership Resource Form


RESNA SIG-11 members are encouraged to fill out this form. The information
will be incorporated into a database and published on this website to:

1. identify individual members of SIG-11 for information dissemination by
mail, fax, or email;

2. aid in contacting SIG-11 members with special expertise to respond to
inquiries from within the SIG, from within RESNA, or from the wider
rehabilitation community;

3. be a resource to all SIG-11 members needing to locate others working in a
similar disability field or regional area; and

4. identify common threads and themes in the experience of the membership to
better plan RESNA conference courses, seminars, and special sessions.

       Individual Information:

                  Name:  
                 Title:  
Company or Institution:  
             Address 1:  
             Address 2:  
                  City:    State:   Zip:  
               Country:  
                 Phone:  
                   FAX:  
      E-Mail Address 1:  
      E-Mail Address 2:  
              Web Page:  


       Membership Status:

        RESNA    SIG-11

       Preferred contact method:

        Mail
        Phone 
        FAX 
        E-Mail

       Title or field of training:

        Consumer
        Educator
        Engineer
        Manufacturer
        Occupational Therapist
        Physical Therapist
        Rehabilitation Technologist
        Speech Therapist
        Vendor
        Other  

       Years in field:

        0-5
        6-10
        11-20
        Over 20

       Services performed:
       Enter 1, 2, or 3 for each entry):
       1 = Most       2 = Next       3 = Least

        Clinical
        Educational
        Research
        Product Development
        Sales
        Other    Type  
        Not applicable 

       Client base: (Check all seen)

        Visual Impairments
        Hearing Impairments
        Speech Impairments
        Cognitive Impairments
        Spinal Cord Injury
        Brain Injury
        CVA - Stroke
        Cerebral Palsy
        MS, ALS
        Other  
        Not applicable

       Client age:

        Adults
        Children
        Both

       Computers, Software, and Product familarity:
       Enter 1, 2, or 3:
       1 = Novice       2 = User       3 = Expert

       Computers:

        PC or MS-DOS compatibles
        Macintosh
        Apple II family
        Other  Type 

       Software:

        Database
        Spreadsheet
        Programming
        Desktop Publishing
        Graphics
        Word Processing
        Communications
        Multimedia, Hypermedia
        Instructional training
        Software interfaces

       Products:

        Adapted interfaces (AFC, Ke:nx)
        Reading machines / screen readers
        Augmentative communication
        Voice recognition
        Speech synthesis
        Computer access software
        Switch input
        Hardware interfaces
        Other  Type  

       Volunteer:

        Review papers / concurrent sessions
        Review software
        Contribute to RESNA News
        Evaluate BBS
        Other  

Briefly list your or your facility's activities:
       
 

Briefly list your computer applications interests:

 

Briefly list resources you can share:

 


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