Test Applicant Survey
PTWDD is seeking participants for an upcoming series of Alpha/Beta test sessions for our new accessibility device currently in development. Testing can be performed on an individual or group basis. Tests are usually about 60 minutes long and pay $50 per individual, per test.
Testing will be conducted weekly; and we would like to fill 6x slots per session. Please complete the below application for consideration.

CONSENT TO COLLECT PERSONAL DATA

As an applicant for the PTWDD accessibility device testing sessions, you hereby acknowledge and give your informed consent that PTWDD may legitimately collect, store, and process the personal data (which has been previously supplied or will be supplied) that was, is, will be conveyed during your participation.
Although we routinely post images of and tell the stories of our participants on our social media outlets; we will not sell, transfer, or otherwise disseminate the personal information you provide to us to any other party without your prior expressed permission.  This would exclude any obligation to do so by applicable state and federal laws and the third party data processor used to process our application (re: Google Forms)

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Email *
First / Last Name *
Phone
Location (City)
Birth Year *
Type of Disability (list any/all that apply) *
Previously used Adaptive Technology Devices *
Cellular Phone Type (check all that apply) *
Required
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