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#20-005297-0005
Supplemental Questionnaire

Last Name
First Name

 

***Please note that your answers on the supplemental questionnaire must correspond to the information provided on your application to receive credit. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.***


1.

Do you have experience with assistive technology? Please list in the box below the assistive technology that you are familiar with.  This information should also be reflected in your application.  If you do not possess experience in this area, put N/A in the box below.

2.

Do you have experience with commercial technologies including MAC OS, Apple iOS, Android, Windows OS, Microsoft Office, and Internet Browsers?  Please describe your experience and where you gained the experience.  This information should also be reflected in your applications.  If you do not possess experience in this area, put N/A in the box below.

3.

Describe your experience with installing, configuring, troubleshooting, and training on assistive technology.  Please describe your experience and where you gained the experience.  This information should also be reflected in your applications.  If you do not possess experience in this area, put N/A in the box below.

4.

Do you have a certification related to assistive technology such as RESNA Assistive Technology Professional (ATP), ACVREP Certified Assistive Technology Instructional Specialist for People with Visual Impairments (CATIS), or certificate/degree in AT or Special Education such as CSUN Assistive Technology Applications Certificate Program (ATACP)?  Please list such certification(s). This information should also be reflected in your applications.  If you do not possess experience in this area, put N/A in the box below.


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