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The Courseware Accessibility Study

Distance Education Survey

(CCE and EvNet)

[Return to Appendix]
NOTE: this form is a copy of the original and is non-functional. You will not be able to submit this form.

Part E: Disability Awareness

We are interested in your experiences with your disability and your knowledge of various aspects of having a disability. In the following 8 questions please select the choice that best describes you or your experiences, and fill in the blank spaces where they are provided.

Enter your Participant ID

1. Do you need any special adaptations to use a computer?

No

 If you answered "NO", skip the next question and go to number 3 ( Jump to item 3)
Yes If you answered "YES", go to the next question, number 2

2. Do you use adaptive computer hardware or software to use a computer
Yes If you answered "YES", skip the rest of this question and go to the next question, number 3 ( Jump to item 3)
No If you answered "NO", rate your level of agreement with each of the statements below. Use a 6-point scale with 1 equalling disagree strongly, and 6 equalling agree strongly. Please do not leave any items blank that are applicable to you.
I do not use adaptive hardware/software (eg. Braille display, software that enlarges what's on the screen) because:

a. it is unavailable to me

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

b. it costs to much

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

c. I am not interested in using it

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

d. it is too difficult to learn

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

e. it is too expensive to maintain

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

f. I don't know how to use it

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

g. the technology makes me anxious

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

h. I am uncertain about where to buy it

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

i. adaptive technology I need to use my computer works poorly for me

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

j. it is impossible for me to get it through a government program or an educational institution lending program

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

k. available computers don't have appropriate adaptive hardware/software on them

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

l. other (specify reason below)

3. We would like to know what disabilities/ impairments you have and how long you have had them.The first part of this question asks No or Yes about specific impairments. Just click Yes on the ones that apply to you.
No Yes totally blind
No Yes visually impaired / partially sighted
No Yes Deaf
No Yes hearing impaired / hard of hearing
No Yes speech or communication impaired
No Yes learning disabled
No Yes wheelchair user
No Yes mobility impaired (eg. walk with difficulty, use a cane)
No Yes difficulty using hands/arms
No Yes health or medically related impairment (eg. diabetes)
No Yes psychological or psychiatric disability
No Yes other (specify impairment / disability)

In this part we want to know how long have you had your disability or multiple disabilities? Please use the 3-point scale where 1=all or most of my life (before age 10), 2=part of my life and 3=recent (past 3 years)

1all or most of my life (before age 10)
2 part of my life
3 recent (past 3 years)

In this part please describe your disability or multiple disabilities
in the box below,that you think might affect your success with online education.


4. Rate your level of agreement with the statements listed below. Use the 6 point scale below, with 1 = disagree strongly, and 6 = agree strongly. Please do not leave any items blank that apply to you.

(Please indicate product names if you know them.)

The following adaptive computer technologies are/could be useful in getting my work done:

a. a screen reader (software that reads what's on the screen)
product name

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

b. software that enlarges what is on the screen
product name

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

c. a scanner
product name

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

d. Braille translation software
product name

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

e. a portable note taking device (not referring to a laptop)
product name

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

f. a large screen monitor
product name

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

g. a Braille printer
product name

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

h. a spell checker
product name

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

i. other specialized software for learning disabilities (eg. word prediction)
product name

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

j. keyboard adaptations (eg. sticky keys)
product name

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

k. mouse adaptations (eg. head mouse, track ball)
product name

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

l. dictation software (voice recognition software that type what you say)
product name

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

m. voice control software (you give voice commands like "file", "open," -eg. VoicePad)
product name

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

n. having material available in electronic format (eg. books, handouts)
product name

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

o. other (specify adaptive hardware / software and product name)
product name

5. Have you taken advantage of a government program to obtain a computer or adaptive computer technologies?

Yes If you answered "YES" skip the next question,
and go to question number 6 ( Jump to item 6)
No If you answered "NO", rate your level of agreement with each of the statements below. Use a 6-point scale like the one above, with 1 = disagree strongly, and 6 = agree strongly. Please do not leave any items blank that are applicable to you.

I have not taken advantage of a government program to obtain a computer or adaptive computer technologies (eg., Braille display, software that enlarges the screen) because:

a. there were too many restrictions

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

b. my own/ my family's income was too high for me to qualify

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

c. my disability was excluded by existing programs

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

d. the waiting period was too long

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

e. I did not want to take the required evaluation

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

f. I was unaware that there were any programs out there for me

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

g. I or my family preferred to buy the equipment I needed

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

h. the process for applying was too complicated

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

i. the equipment I need was unavailable through existing programs

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

j. other (specify reason below)

6. Did you take advantage of a government program?

No If you did not take advantage of a government program, skip the next question,
and go to question number 7. ( Jump to item 7)
Yes If you did take advantage of a government program, continue with the parts of question 6.

If you answered "Yes", rate your level of agreement with each of the statements below. Use a 6-point scale, like the one above, with 1 = disagree strongly, and 6 = agree strongly. Please do not leave any items blank that are applicable to you.

My experience with a goverment program has been that:

a. there were many restrictive rules and regulations

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

b. I had no say in what hardware/software I recieved

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

c. the equipment I recieved met my needs

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

d. I recieved excellent training on the technology

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

e. the waiting period was very long

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

f. the program's documentation was unavailable in a format I could read myself (eg. no large print or tape)

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

g. the program was flexible in meeting my needs

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

h. contacting the necessary people to discuss my needs was easy

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

i. the process for applying was complicated

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

j. the equipment I recieved was up-to-date

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

k. the evaluation process was unpleasant

1 disagree strongly
2 disagree somewhat
3 disagree slightly
4 agree slightly
5 agree somewhat
6 agree strongly

l. other (specify experience below)

7. Indicate whether you agree or disagree with the following statements

If an employer is interviewing you as new employee or for promotion, they may ask:

a. if you have a disability

agree disagree
b. if you have ever received psychiatric care

agree disagree
c. whether you have a condition that would affect your ability to do the job

agree disagree
d. if you have a condition that should be considered during selection

agree disagree
e. whether you have ever receive worker's compensation

agree disagree
f. whether you use any medications

agree disagree
g. how old you are

agree disagree
h. for the name of your family doctor

agree disagree
i. about your marital status

agree disagree

8. On average, how many hours per week do you spend in the following activities:

Hours doing light recreational activities (eg. walking, sight seeing, playing board games)
Hours playing physical sports (eg. hockey, soccer, basketball, cycling )
Hours involved in community activities (eg. volunteering)
Hours in educational activities (taking a course, learning a new skill, teaching, research)
Hours with family (eg. at home with your family, family activities)
Hours with friends (eg. visiting others or entertaining others at your home)
Hours doing individual activities (eg, reading, watching television, on your computer)
Hours in other activities (specify below)

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