VSAC Discovery Call – Parent/Guardian Questions

To receive $20 for your opinion on a new wearable AAC device, please fill out this form. Then click submit, afterwhich you will receive a confirmation email along with a link to the schedule where you can sign up for the call.

After the call is completed, you will be sent $20 on PayPal or Venmo (your choice) and entered into a drawing for $100. The drawing will be held on April 5th, 2024.

NOTE: This financial offer is limited to the first 10 people who complete the Discovery Call.

THIS SECTION FOCUSES ON YOU

Your First Name *

Your Last Name *

Your Phone Number *

Current City of Residence *

Current State of Residence *

Your Email Address *

Your Facebook Profile Link *

THIS SECTION FOCUSES ON THE PERSON YOU ARE RESPONSIBLE FOR

Age of Person who is Nonverbal *

Condition, Syndrome, or anomally or Person who is Nonverbal

What methods of communication have they tried in the past: *

• Facial Cues
• Verbal Cues
• Gestures
• Sign Language
• Picture Books
• Electronic Communication Boards
• Other

Check all that apply.

Please describe the other method(s) of communication they have tried in the past. *

What methods of communication are they currently most successful using? *

• Facial Cues
• Verbal Cues
• Gestures
• Sign Language
• Picture Books
• Electronic Communication Boards
• Other

Check all that apply.

Please describe the other method(s) of communication they are currently most successful using. *

Please describe their signing abilities, including which sign system they use and approximately how many signs they know. *

How many words/phrases are in their book? *

What best describes how the picture book is used? *

• They always have their book with them and use it regularly with family and strangers alike.
• They always have their book with them and use it regularly with family or close friends only.
• They always have their book with them when they go out in the community.
• Sometimes they leave their book behind and have to make due without it.
• It is hard for them to remember to bring their book with them and is often left behind.
• Other

How many words/phrases are programmed into their electronic communication board? *

What best describes how the electronic communication board is used? *

• They always have their board charged and with them, and use it regularly with family and strangers alike.
• They always have their board charged and with them, and use it regularly with family or close friends only.
• They always have their board charged and with them when they go out in the community.
• Sometimes they leave their board behind and have to make due without it.
• It is hard for them to remember to bring their board with them and is often left behind.
• It is hard to use the board a lot because it runs out of power or gets turned off.
• Other

Please provide any more details you think might help us understand their nonverbal abilities and needs here:

Submit