QuestionnairesBeyond Disability Introductory questionnaire
Name in Full (Disabled):
Age:
Address:
Post Code:
Phone:
Email:
Carer:
Disability (Must be mobility disabled)
Housebound ?
YesNo
Pension or Disability Support Pension?
Type of computer/modem in house (if any?)
Are you connected to the Internet?
What ISP do you use?
Monthly Internet costs?
Are you comfortable using a computer?
Have you had any computer training?
What do you currently want out of Internet access?
Will you connect to a commercial ISP with monthly access cost Ave $25 up to $40 for unlimited use, and also the telephone access call costs?
Would you prefer $10 per month for 2 hours per day access from Beyond Disability?
Check the following items of interest:
Contact Disability Support Groups :
Self Education :
Chat :
Access Government services :
Home Shopping :
Newspapers :
Leisure items :
Simply surf the net :
E-mail :
TAFE Course :
Others - List :
Is there anything you want to learn about (ie languages, computers, writing, disability support etc)?
Can you afford $10 per annum per person non-voting membership fee (we can't function without some financial resources)?
Can you introduce family members and carers to Beyond Disability?
Do you have any ideas where we can obtain donated PC's & modems or cash donations to fund PC upgrades / repairs?
Can you help with contacting organisations for donated computer equipment ?
Do you want to be in the pilot program ?
If our group becomes large enough to obtain buyer discounts would you use it as your whitegoods purchaser? (if N, why?)
YesNoNo - Why?
Any other comments you have:
