Your views on Social Networking websites

1. About you

In order for us to assess the impact of your impairment on your use of social networking websites please tell us about your impairment.

1a. What is the nature of your impairment?

Dyslexia
Mobility (physical impairment)
Mental health difficulty
Blind/partially sighted
Progressive disability/chronic illness (e.g. MS, Cancer)
Deaf/hearing loss
Learning disability
Multiple impairments
Other (please state)


1b. If you adapt your computer please tell us how

2. Contact details (optional)

Name:


Email:


Phone number:

3. User testing & video interviews

If you live in the Greater London area and would be interested in participating in a user test or video interview please select this box and leave your contact details

I live in the Greater London area and would be interested in participating in a user test or video interview

4. AbilityNet User testing opportunities

Yes I am interested in participating in future disabled user testing for AbilityNet

If you want to participate in video interviews or join our pool of user testers please ensure you have given us your contact details.

5. Can we contact you?

Can we contact you for further information?

Yes
No

I understand that AbilityNet will use the information I provide for educational purposes. I understand that all information will be presented anonymously. I give AbilityNet permission to use the information I provide for these purposes.
Please select this box to allow us to use your information. If you do not select this box then you can not continue.

---