Full Name*Age*123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899Email* Phone Number*Country*Guardian Contact Full Name*Guardian Contact Number*Occupation Student Employed Non – Employed Qualifications* Post Graduate University High school Secondary School Primary School Language Preference Arabic English Sign Language How do you access the computer? (More than one)* Doesn’t access to computer Keyboard and Mouse Specialized Software Eye Gaze Adapted Keyboard & Mouse Joysticks Touchscreen Speech Recognition Switch Other Other (How do you access the computer?)How do you prefer to communicate? (More than one or none)* Verbal communication Sign language AAC Systems Body gesture Other Other (How do you prefer to communicate?)Do you require additional environmental support? No Yes If the answer is “Yes” kindly specify Sensitive to light Sensitive to color Sensitive to sound Crowdedness Would you require a personal assistance? Yes No Do you have any innovation idea that requires digital fabrication support? Yes No If the answer is “Yes” kindly specify the ideaApplication Name Skip back to main navigation
