Form 2 Test

Respondent Profile
This section is intended to get a better sense of the respondent's profile. All answers are for internal use only.
1.What is your name? * Required
Any details provided will be strictly confidential.
2.What is your affiliation?
Any details provided will be strictly confidential.
3.What is your position?
Any details provided will be strictly confidential.
4.Email address and/or phone number? * Required
Any details provided will be strictly confidential.
5.What is your gender? * Required
6.In what age group do you belong? * Required
7.What is the highest educational level you have attained? * Required
8.What is your preferred language of communication? * Required
Other Languages
9.Are you currently employed or self-employed or have been employed for the past 5 years. * Required
10.Do you identify as a Person with Disability? If so, please select one or more from the following disability types. * Required

Assistive Technology
This section is intended to get a better sense of the respondent's profile. All answers are for internal use only.
11.If you are a person with disability, what kind of Assistive Technology do you use in your daily life? Please select all that apply. * Required
Other Type of Assistive Technology * Required
12.If you are a person with a disability that uses accessibility features on a mainstream device, what is the type of device that you use on a daily basis? Please choose all that apply. * Required
Other Type of Device * Required
13.If you are a person with a disability that uses accessibility features on a mainstream device, what operating system do use on a daily basis? Choose all that apply. * Required
Other Type of Device * Required
14.If you are interested in being further involved in the Mada Innovation Program, kindly provide us with your full name, email address, telephone number and place of residence.
Any details provided will be strictly confidential.

Innovation
The purpose of this section is to understand the needs of innovations
17.What kind of innovation/solutions are you looking for?
18.What kind of innovation/solutions are you looking for?
19.How innovations can improve your life?
20.In which domains or areas the innovations improve your life?
21.Are you using technologies that are not localized or adapted to your culture? if yes, could you cite the name of the technologies?
JIP ID