Page 9, National Resource Center for Blind Musicians Survey, February 2002
we'd like to know who you are, your music needs, and suggestions for service.

This is a form which you can fill out and automatically submit to us through your E-mail program. If you are using a screen reader, you will want to set it into its mode for working with forms. You may leave questions that do not apply blank. Questions with combo boxes can be left at the top choice of --- if they do not apply to you. The form follows:

 

Name:

Address:

City:

State:

ZIP Code:

Phone No:

E-Mail:

Website URL:

I will be beginning the following grade in the Fall:

My musical instrument is

I am in college taking music courses, or will be starting this fall; Name of College

(For the next questions,please choose the Yes or No button or leave as a series of dashes if not applicable.)

I am a visually impaired adult with musical interests.

I am a professional blind musician.

I am a parent of a visually impaired student.

I am a teacher of a visually impaired student.

I read contracted English braille.

I read braille music.

I would like to learn or improve my use of braille music.

I would like to learn how to use accessible music technology.

I read large print or use a low vision reading aid.

Do you have access to a computer?

Are you comfortable accessing the Internet?

If a course on braille music or music technology were available online would you take it?

Would you pay for such courses?

Please contact me about any programs you may have or know of for college music preparation.

I am a student younger than college age, and am interested in a workshop for me and others in my area.

Please include me on your list of teachers to receive our research questionnaire on distance learning.
Please include me on your regular mailing list to receive news from the National Resource Center for Blind Musicians.

Please inform me of activities that take place in my geographic area.

I would be interested in attending a workshop on music teaching strategies if it is offered in my geographic area.

If there is a choice of format in which to receive mailings, I would prefer mail in:

Please remove me from your regular mailing list.

Please comment on any music-related or music-teaching issues of concern to you. Thank you.

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