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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link=blue vlink=purple><div class=WordSection1><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>Thanks completed. Angie <o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><div><div style='border:none;border-top:solid #B5C4DF 1.0pt;padding:3.0pt 0in 0in 0in'><p class=MsoNormal><b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>From:</span></b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'> Capchapohio [mailto:capchapohio-bounces@nfbnet.org] <b>On Behalf Of </b>Carol Akers via Capchapohio<br><b>Sent:</b> Saturday, August 27, 2016 11:39 AM<br><b>To:</b> Capital Chapter (Columbus Ohio) Mailing List; NFB of Ohio Announcement and Discussion List<br><b>Cc:</b> Carol Akers<br><b>Subject:</b> [Capchapohio] {Spam?} Fw: Survey to Help Determine Need for Vision Services<o:p></o:p></span></p></div></div><p class=MsoNormal><o:p> </o:p></p><div><div id="yui_3_16_0_ym19_1_1472312051892_5509"><p class=MsoNormal style='background:white'><span style='font-size:8.0pt;font-family:"Helvetica","sans-serif";color:black'>We all know there is a lack of services in Ohio and therefore this survey is important to the blind and visually impaired of Ohio. Please complete this if you would and share it with others. We never know what impact it could have, but what we do know is a silent voice is never heard.<o:p></o:p></span></p></div><div id="yui_3_16_0_ym19_1_1472312051892_5509"><p class=MsoNormal style='background:white'><span style='font-size:8.0pt;font-family:"Helvetica","sans-serif";color:black'>Carol Akers<o:p></o:p></span></p></div><div id="yui_3_16_0_ym19_1_1472312051892_5524"><p class=MsoNormal style='margin-bottom:12.0pt;background:white'><span style='font-size:8.0pt;font-family:"Helvetica","sans-serif";color:black'><o:p> </o:p></span></p></div><div id="yui_3_16_0_ym19_1_1472312051892_5739"><p class=MsoNormal style='background:white'><span class=qtd-expansion-text><span style='font-size:8.0pt;font-family:"Helvetica","sans-serif";color:black'>Show original message</span></span><span style='font-size:8.0pt;font-family:"Helvetica","sans-serif";color:black'> <o:p></o:p></span></p></div><div id="yui_3_16_0_ym19_1_1472312051892_5380"><div id="yui_3_16_0_ym19_1_1472312051892_5379"><div id="yui_3_16_0_ym19_1_1472312051892_5378"><div id="yui_3_16_0_ym19_1_1472312051892_5525"><p class=MsoNormal style='background:white'><span style='font-size:10.0pt;font-family:"Arial","sans-serif";color:black'>On Saturday, August 27, 2016 11:26 AM, Vicky Prahin <<a href="mailto:Vicky@hadley.edu">Vicky@hadley.edu</a>> wrote:</span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div><p class=MsoNormal style='margin-bottom:12.0pt;background:white'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p> </o:p></span></p><div id="yui_3_16_0_ym19_1_1472312051892_5377"><div id=yiv1112393728><div id="yui_3_16_0_ym19_1_1472312051892_5376"><div id="yui_3_16_0_ym19_1_1472312051892_5375"><div><p class=MsoNormal style='background:white'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>Please help us get back some of the services the Vision Center provided. You can fill out the survey by pressing Enter on the link or look below it for the questions and just copy and paste them into a reply, with your answers. We need as many people as possible to respond; otherwise, this can’t happen! If there is no need assessed, those considering spending the time and money on this project will not act.<o:p></o:p></span></p></div><div><p class=MsoNormal style='background:white'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <o:p></o:p></span></p></div><div id="yui_3_16_0_ym19_1_1472312051892_5374"><p class=MsoNormal style='background:white'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>Reply to me or to Katie Frederick at <a href="mailto:acbo.director@gmail.com" target="_blank">acbo.director@gmail.com</a>. Share this with anyone else you know who has an interest. <o:p></o:p></span></p></div><div><p class=MsoNormal style='background:white'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <o:p></o:p></span></p></div><div><p class=MsoNormal style='background:white'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <o:p></o:p></span></p></div><div><p class=MsoNormal style='background:white'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <o:p></o:p></span></p></div><div><div><table class=MsoNormalTable border=0 cellspacing=0 cellpadding=0 width="100%" style='width:100.0%;background:#673AB7'><tr><td style='padding:0in 0in 0in .25in'><div><p class=MsoNormal>Please take five minutes and help collect data to determine the need for vision services in Columbus. Thank you in advance for your time and assistance.<br><br> <span style='border:solid windowtext 1.0pt;padding:0in'><img border=0 width=100 height=100 id="yiv1112393728_x005f_x0000_i1025" src="cid:image001.jpg@01D206CB.357D7D70" alt="Image removed by sender. Google Forms"></span><o:p></o:p></p></div></td></tr></table><div><div><p class=MsoNormal style='background:#EDE7F6'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <o:p></o:p></span></p></div><div align=center><table class=MsoNormalTable border=0 cellspacing=0 cellpadding=0 width="100%" style='width:100.0%;max-width:672px;min-width:154px'><tr><td style='padding:0in 0in 0in 0in'><div><p class=MsoNormal style='line-height:13.5pt'><b><span style='font-size:10.0pt;color:#424242'>Having trouble viewing or submitting this form?</span></b><o:p></o:p></p></div></td></tr><tr><td style='padding:0in 0in 0in 0in'></td></tr><tr><td style='padding:0in 0in 0in 0in'><table class=MsoNormalTable border=0 cellspacing=0 cellpadding=0 width="100%" style='width:100.0%'><tr><td style='padding:0in 0in 0in 0in'><div><p class=MsoNormal><a href="https://docs.google.com/forms/d/e/1FAIpQLSd5qsxts0GyUG3ngiuFn_alJ9sa0AAcR0Kgr60fnc04n-dnAw/viewform?c=0&w=1&usp=mail_form_link" target="_blank"><b><span style='font-size:10.0pt;color:white;text-transform:uppercase;background:#673AB7;text-decoration:none'>FILL OUT IN GOOGLE FORMS</span></b></a><o:p></o:p></p></div></td></tr></table></td></tr><tr><td style='padding:0in 0in 0in 0in'></td></tr></table></div><div style='border:none;border-bottom:solid #E0E0E0 1.0pt;padding:0in 0in 0in 0in;max-width:624px;min-width:154px'><p class=MsoNormal align=center style='text-align:center;background:white'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <o:p></o:p></span></p><div align=center><table class=MsoNormalTable border=0 cellspacing=0 cellpadding=0 width="100%" style='width:100.0%;background:white'><tr><td style='padding:0in 0in 0in 0in'></td></tr><tr><td style='padding:0in 0in 0in 0in'></td></tr></table></div><div><p class=MsoNormal align=center style='text-align:center;line-height:18.0pt;background:white'><span style='font-size:15.0pt;font-family:"Helvetica","sans-serif";color:black'><a href="https://docs.google.com/forms/d/e/1FAIpQLSd5qsxts0GyUG3ngiuFn_alJ9sa0AAcR0Kgr60fnc04n-dnAw/viewform?c=0&w=1&usp=mail_form_link" target="_blank"><span style='color:#673AB7;text-decoration:none'>Vision Services Need Survey</span></a></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div><div><p class=MsoNormal align=center style='text-align:center;background:white'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:#424242'>Due to the closing of Vision and Vocational Services several years ago, there is a lack of service and support available to the Columbus/Central Ohio area. This survey aims to explore the need for said services in this part of the state.</span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div><div><div><div style='margin-top:9.0pt;margin-bottom:9.0pt'><div style='margin-bottom:.25in;max-width:100%'><div style='margin-top:9.95pt;margin-bottom:9.95pt'><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> </span></b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div><div style='margin-bottom:9.95pt'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>1. Do you feel you need instruction in daily living skills or activities? </span></b><span class=yiv1112393728ss-required-asterisk><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:#C43B1D'>*</span></b></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div></div><div style='margin-top:1.2pt;margin-bottom:3.0pt'><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:#666666'>Please make one selection.</span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;line-height:15.6pt;background:white;vertical-align:middle'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:black'>o</span><span style='font-size:7.0pt;font-family:"Helvetica","sans-serif";color:black'> </span><span class=yiv1112393728ss-choice-item-control><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>( )</span></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <span class=yiv1112393728ss-choice-label>Yes, I could benefit from some daily living skills training</span> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;line-height:15.6pt;background:white;vertical-align:middle'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:black'>o</span><span style='font-size:7.0pt;font-family:"Helvetica","sans-serif";color:black'> </span><span class=yiv1112393728ss-choice-item-control><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>( )</span></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <span class=yiv1112393728ss-choice-label>No, I do not need training in this area at this time.</span> <o:p></o:p></span></p></div></div></div></div><div><div style='margin-top:9.0pt;margin-bottom:9.0pt'><div style='margin-bottom:.25in;max-width:100%'><div style='margin-top:9.95pt;margin-bottom:9.95pt'><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> </span></b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div><div style='margin-bottom:9.95pt'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>2. Do you feel you need instruction in the use of a computer, a smart phone or other access technology? </span></b><span class=yiv1112393728ss-required-asterisk><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:#C43B1D'>*</span></b></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div></div><div style='margin-top:1.2pt;margin-bottom:3.0pt'><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:#666666'>Please choose one response</span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;line-height:15.6pt;background:white;vertical-align:middle'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:black'>o</span><span style='font-size:7.0pt;font-family:"Helvetica","sans-serif";color:black'> </span><span class=yiv1112393728ss-choice-item-control><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>( )</span></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <span class=yiv1112393728ss-choice-label>Yes</span> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;line-height:15.6pt;background:white;vertical-align:middle'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:black'>o</span><span style='font-size:7.0pt;font-family:"Helvetica","sans-serif";color:black'> </span><span class=yiv1112393728ss-choice-item-control><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>( )</span></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <span class=yiv1112393728ss-choice-label>No</span> <o:p></o:p></span></p></div></div></div></div><div><div style='margin-top:9.0pt;margin-bottom:9.0pt'><div style='margin-bottom:.25in;max-width:100%'><div style='margin-top:9.95pt;margin-bottom:9.95pt'><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> </span></b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div><div style='margin-bottom:9.95pt'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>3. Do you feel you need instruction in orientation and mobility/cane travel skills? </span></b><span class=yiv1112393728ss-required-asterisk><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:#C43B1D'>*</span></b></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div></div><div style='margin-top:1.2pt;margin-bottom:3.0pt'><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:#666666'>Please choose one</span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;line-height:15.6pt;background:white;vertical-align:middle'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:black'>o</span><span style='font-size:7.0pt;font-family:"Helvetica","sans-serif";color:black'> </span><span class=yiv1112393728ss-choice-item-control><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>( )</span></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <span class=yiv1112393728ss-choice-label>Yes</span> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;line-height:15.6pt;background:white;vertical-align:middle'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:black'>o</span><span style='font-size:7.0pt;font-family:"Helvetica","sans-serif";color:black'> </span><span class=yiv1112393728ss-choice-item-control><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>( )</span></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <span class=yiv1112393728ss-choice-label>No</span> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;line-height:15.6pt;background:white;vertical-align:middle'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:black'>o</span><span style='font-size:7.0pt;font-family:"Helvetica","sans-serif";color:black'> </span><span class=yiv1112393728ss-choice-item-control><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>( )</span></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <span class=yiv1112393728ss-choice-label>Other:</span> <o:p></o:p></span></p></div></div></div></div><div><div style='margin-top:9.0pt;margin-bottom:9.0pt'><div style='margin-bottom:.25in;max-width:100%'><div style='margin-top:9.95pt;margin-bottom:9.95pt'><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> </span></b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div><div style='margin-bottom:9.95pt'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>4. If you are low vision, do you currently need help with low vision services/magnifiers or other aids and appliances? </span></b><span class=yiv1112393728ss-required-asterisk><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:#C43B1D'>*</span></b></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div></div><div style='margin-top:1.2pt;margin-bottom:3.0pt'><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:#666666'>Please choose one response below.</span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;line-height:15.6pt;background:white;vertical-align:middle'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:black'>o</span><span style='font-size:7.0pt;font-family:"Helvetica","sans-serif";color:black'> </span><span class=yiv1112393728ss-choice-item-control><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>( )</span></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <span class=yiv1112393728ss-choice-label>No, I do not use low vision aids/appliances</span> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;line-height:15.6pt;background:white;vertical-align:middle'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:black'>o</span><span style='font-size:7.0pt;font-family:"Helvetica","sans-serif";color:black'> </span><span class=yiv1112393728ss-choice-item-control><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>( )</span></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <span class=yiv1112393728ss-choice-label>Yes, I could benefit from training.</span> <o:p></o:p></span></p></div></div></div></div><div><div style='margin-top:9.0pt;margin-bottom:9.0pt'><div style='margin-bottom:.25in;max-width:100%'><div style='margin-top:9.95pt;margin-bottom:9.95pt'><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> </span></b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div><div style='margin-bottom:9.95pt'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>5. In the past ten years, where have you gone to obtain daily living skills techniques, orientation and mobility training, and/or assistive technology instruction? </span></b><span class=yiv1112393728ss-required-asterisk><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:#C43B1D'>*</span></b></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div></div><div style='margin-top:1.2pt;margin-bottom:3.0pt'><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:#666666'>Please mark all that apply.</span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;line-height:15.6pt;background:white;vertical-align:middle'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:black'>o</span><span style='font-size:7.0pt;font-family:"Helvetica","sans-serif";color:black'> </span><span class=yiv1112393728ss-choice-item-control><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>[ ]</span></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <span class=yiv1112393728ss-choice-label>Bureau of Services for the Visually Impaired (BSVI)</span> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;line-height:15.6pt;background:white;vertical-align:middle'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:black'>o</span><span style='font-size:7.0pt;font-family:"Helvetica","sans-serif";color:black'> </span><span class=yiv1112393728ss-choice-item-control><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>[ ]</span></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <span class=yiv1112393728ss-choice-label>Vision and Vocational Services</span> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;line-height:15.6pt;background:white;vertical-align:middle'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:black'>o</span><span style='font-size:7.0pt;font-family:"Helvetica","sans-serif";color:black'> </span><span class=yiv1112393728ss-choice-item-control><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>[ ]</span></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <span class=yiv1112393728ss-choice-label>Functional Training Services</span> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;line-height:15.6pt;background:white;vertical-align:middle'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:black'>o</span><span style='font-size:7.0pt;font-family:"Helvetica","sans-serif";color:black'> </span><span class=yiv1112393728ss-choice-item-control><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>[ ]</span></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <span class=yiv1112393728ss-choice-label>Cleveland or Northwest Ohio Sight Center</span> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;line-height:15.6pt;background:white;vertical-align:middle'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:black'>o</span><span style='font-size:7.0pt;font-family:"Helvetica","sans-serif";color:black'> </span><span class=yiv1112393728ss-choice-item-control><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>[ ]</span></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <span class=yiv1112393728ss-choice-label>Cincinnati Association for the Blind</span> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;line-height:15.6pt;background:white;vertical-align:middle'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:black'>o</span><span style='font-size:7.0pt;font-family:"Helvetica","sans-serif";color:black'> </span><span class=yiv1112393728ss-choice-item-control><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>[ ]</span></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <span class=yiv1112393728ss-choice-label>Other:</span> <o:p></o:p></span></p></div></div></div></div><div><div style='margin-top:9.0pt;margin-bottom:9.0pt'><div style='margin-bottom:.25in;max-width:100%'><div style='margin-top:9.95pt;margin-bottom:9.95pt'><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> </span></b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div><div style='margin-bottom:9.95pt'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>6. Today, where would you go to obtain training related to daily living skills, orientation and mobility, and/or assistive technology? </span></b><span class=yiv1112393728ss-required-asterisk><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:#C43B1D'>*</span></b></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div></div><div style='margin-top:1.2pt;margin-bottom:3.0pt'><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:#666666'>Please mark all that apply.</span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;line-height:15.6pt;background:white;vertical-align:middle'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:black'>o</span><span style='font-size:7.0pt;font-family:"Helvetica","sans-serif";color:black'> </span><span class=yiv1112393728ss-choice-item-control><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>[ ]</span></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <span class=yiv1112393728ss-choice-label>Bureau of Services for the Visually Impaired (BSVI)</span> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;line-height:15.6pt;background:white;vertical-align:middle'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:black'>o</span><span style='font-size:7.0pt;font-family:"Helvetica","sans-serif";color:black'> </span><span class=yiv1112393728ss-choice-item-control><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>[ ]</span></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <span class=yiv1112393728ss-choice-label>Functional Training Services</span> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;line-height:15.6pt;background:white;vertical-align:middle'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:black'>o</span><span style='font-size:7.0pt;font-family:"Helvetica","sans-serif";color:black'> </span><span class=yiv1112393728ss-choice-item-control><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>[ ]</span></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <span class=yiv1112393728ss-choice-label>An independent living center in your community</span> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;line-height:15.6pt;background:white;vertical-align:middle'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:black'>o</span><span style='font-size:7.0pt;font-family:"Helvetica","sans-serif";color:black'> </span><span class=yiv1112393728ss-choice-item-control><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>[ ]</span></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <span class=yiv1112393728ss-choice-label>Seek assistance from a certified known professional in the area</span> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;line-height:15.6pt;background:white;vertical-align:middle'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:black'>o</span><span style='font-size:7.0pt;font-family:"Helvetica","sans-serif";color:black'> </span><span class=yiv1112393728ss-choice-item-control><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>[ ]</span></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <span class=yiv1112393728ss-choice-label>Other:</span> <o:p></o:p></span></p></div></div></div></div><div><div style='margin-top:9.0pt;margin-bottom:9.0pt'><div style='margin-bottom:.25in;max-width:100%'><div style='margin-top:9.95pt;margin-bottom:9.95pt'><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> </span></b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div><div style='margin-bottom:9.95pt'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>7. Would you be willing to pay a modest fee for the service and equipment needed, if there were no third party resources available to you? </span></b><span class=yiv1112393728ss-required-asterisk><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:#C43B1D'>*</span></b></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div></div><div style='margin-top:1.2pt;margin-bottom:3.0pt'><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:#666666'>Please mark one response.</span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;line-height:15.6pt;background:white;vertical-align:middle'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:black'>o</span><span style='font-size:7.0pt;font-family:"Helvetica","sans-serif";color:black'> </span><span class=yiv1112393728ss-choice-item-control><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>( )</span></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <span class=yiv1112393728ss-choice-label>Yes.</span> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;line-height:15.6pt;background:white;vertical-align:middle'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:black'>o</span><span style='font-size:7.0pt;font-family:"Helvetica","sans-serif";color:black'> </span><span class=yiv1112393728ss-choice-item-control><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>( )</span></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <span class=yiv1112393728ss-choice-label>No.</span> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;line-height:15.6pt;background:white;vertical-align:middle'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:black'>o</span><span style='font-size:7.0pt;font-family:"Helvetica","sans-serif";color:black'> </span><span class=yiv1112393728ss-choice-item-control><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>( )</span></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <span class=yiv1112393728ss-choice-label>maybe</span> <o:p></o:p></span></p></div></div></div></div><div><div style='margin-top:9.0pt;margin-bottom:9.0pt'><div style='margin-bottom:.25in;max-width:100%'><div style='margin-top:9.95pt;margin-bottom:9.95pt'><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> </span></b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div><div style='margin-bottom:9.95pt'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>8. Do you currently face challenges obtaining or maintaining employment? </span></b><span class=yiv1112393728ss-required-asterisk><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:#C43B1D'>*</span></b></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div></div><div style='margin-top:1.2pt;margin-bottom:3.0pt'><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:#666666'>Please choose one response.</span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;line-height:15.6pt;background:white;vertical-align:middle'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:black'>o</span><span style='font-size:7.0pt;font-family:"Helvetica","sans-serif";color:black'> </span><span class=yiv1112393728ss-choice-item-control><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>( )</span></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <span class=yiv1112393728ss-choice-label>No, employment is not a challenge for me at this time.</span> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;line-height:15.6pt;background:white;vertical-align:middle'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:black'>o</span><span style='font-size:7.0pt;font-family:"Helvetica","sans-serif";color:black'> </span><span class=yiv1112393728ss-choice-item-control><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>( )</span></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <span class=yiv1112393728ss-choice-label>Yes, obtaining/maintaining employment is a challenge for me.</span> <o:p></o:p></span></p></div></div></div></div><div><div style='margin-top:9.0pt;margin-bottom:9.0pt'><div style='margin-bottom:.25in;max-width:100%'><div style='margin-top:9.95pt;margin-bottom:9.95pt'><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> </span></b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div><div style='margin-bottom:9.95pt'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>9. As a result of your blindness/visual impairment, do you have difficulty performing daily living skills tasks? </span></b><span class=yiv1112393728ss-required-asterisk><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:#C43B1D'>*</span></b></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div></div><div style='margin-top:1.2pt;margin-bottom:3.0pt'><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:#666666'>Please choose one response.</span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;line-height:15.6pt;background:white;vertical-align:middle'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:black'>o</span><span style='font-size:7.0pt;font-family:"Helvetica","sans-serif";color:black'> </span><span class=yiv1112393728ss-choice-item-control><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>( )</span></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <span class=yiv1112393728ss-choice-label>No</span> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;line-height:15.6pt;background:white;vertical-align:middle'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:black'>o</span><span style='font-size:7.0pt;font-family:"Helvetica","sans-serif";color:black'> </span><span class=yiv1112393728ss-choice-item-control><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>( )</span></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <span class=yiv1112393728ss-choice-label>Yes, I face challenges performing daily living skills tasks.</span> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;line-height:15.6pt;background:white;vertical-align:middle'><span style='font-size:10.0pt;font-family:"Helvetica","sans-serif";color:black'>o</span><span style='font-size:7.0pt;font-family:"Helvetica","sans-serif";color:black'> </span><span class=yiv1112393728ss-choice-item-control><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>( )</span></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <span class=yiv1112393728ss-choice-label>Other:</span> <o:p></o:p></span></p></div></div></div></div><div><div style='margin-top:9.0pt;margin-bottom:9.0pt'><div style='margin-bottom:.25in;max-width:100%'><div style='margin-top:9.95pt;margin-bottom:9.95pt'><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> </span></b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div><div style='margin-bottom:9.95pt'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <o:p></o:p></span></p></div><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'>10. What Products or Services for people who are blind or visually impaired do you feel are lacking in Greater Columbus? </span></b><span class=yiv1112393728ss-required-asterisk><b><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:#C43B1D'>*</span></b></span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div></div><div style='margin-top:1.2pt;margin-bottom:3.0pt'><div style='margin-left:.5in'><p class=MsoNormal align=center style='text-align:center;background:white;vertical-align:middle'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:#666666'>Please type your answer. </span><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p></o:p></span></p></div></div></div></div></div><div style='margin-top:9.0pt;margin-bottom:9.0pt'><div align=center><table class=MsoNormalTable border=0 cellspacing=3 cellpadding=0 style='margin-left:.5in' id=yiv1112393728navigation-table><tr><td style='padding:.75pt .75pt .75pt .75pt;max-width:100%;display:inline-block' id=yiv1112393728navigation-buttons><div style='margin-bottom:.25in'><p class=MsoNormal>[Submit] <o:p></o:p></p></div></td></tr></table></div></div></div></div></div></div><div><p class=MsoNormal style='background:white'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'> <o:p></o:p></span></p></div></div></div></div></div><p class=MsoNormal style='margin-bottom:12.0pt;background:white'><span style='font-size:9.5pt;font-family:"Helvetica","sans-serif";color:black'><o:p> </o:p></span></p></div></div></div></div></div></div></body></html>