Download the Appendix of Application Form in
PDF format (55 KB) and Word Document (88 KB)

APPENDIX OF APPLICATION FORM
FOR
ICT for All: Training of ICT for Persons with Print Disability

Please submit all pertinent documents and your answers to this questionnaire in typewritten form together with your Fellowship Application Form.
*This appendix is available at http//www.apcdproject.org/trainings/2007/daisy

TITLE	Mr. Ms. Mrs. Dr.	NAME	(captical letter)
GENDER	MALE FEMALE	FAMILY NAME	GIVEN NAME	MIDDLE NAME
BIRTH DATE (Day/Month/Year):
PASSPORT NUMBER: PASSPORT EXPIRY DATE (Day/Month/Year):
HOME ADDRESS:   TELEPHONE NUMBER (Country Code/Area Code/Number): FAX NUMBER (Country Code/Area Code/Number):
NAME OF THE ORGANIZATION:   ADDRESS:   TELEPHONE NUMBER (Country Code/Area Code/Number): FAX NUMBER (Country Code/Area Code/Number):   E-MAIL ADDRESS:

Page break

DISABILITIES (IF ANY) YES. NO.	TYPE OF DISABILITIES	Physical Disability Hearing Disability Visual Disability Intellectual Disability Mental Disability Other
	USAGE OF ASSISTIVE DEVICES: YES NO DETAIL OF YOUR ASSISTIVE DEVICES: Power/electronic wheelchair ( Wet battery Dry battery) Wheelchair Crutch (es) White cane Other (                                ) NECESSITY OF A PERSONAL ASSISTANT FOR THE TRAINING: YES => (Details) NO NECESSITY OF A SIGN INTERPRETER FOR THE TRAINING: YES => (Details) NO
DIETARY REQUIREMENT (IF ANY)
I hereby certify that all the provided information is correct, accurate and complete to the best of my knowledge. In the event that I suffer injury, illness or death during the course of my participation in the program/course, I shall hold the Royal Thai Government, the Government of Japan, Japan International Cooperation Agency (JICA) and/or the Asia-Pacific Development Center on Disability harmless and without any liability whatsoever for compensation towards myself, my legal representatives and/or my heirs. Should I cause any person loss of property, injury, illness or death during the course of my participation in the program/course, I shall be fully responsible and liable for the said person without reference whatsoever to the Royal Thai Government, the Government of Japan, Japan International Cooperation Agency (JICA) and/or the Asia-Pacific Development Center on Disability.     SIGNATURE OF NOMINEE PRINTED NAME OF NOMINEE (________________________________) DATE:

QUESTIONNAIRE

• Q1. Is your organization producing information materials for persons with print disability?
  • In what format are you producing information?
    1. Normal Print,
    2. talking book,
    3. Braille,
    4. Multimedia in Digital Format,
    5. DAISY,
    6. Other __________________________
  • How many books/documents per month? ________________________
  • What kind of information? (e.g. text books, novels, comic, etc) _______________________________________________________
  • How many staffs are working for this production? ____________
  • How many computers do you have for the production? ________________________
  • What kid of software are you using for this production? _______________________________________________________
  • Which organizations or people can receive/borrow these materials? (e.g. inclusive school, university, Braille library, etc) ______________________________________________________________
• Q2. What is your organization’s future plan for production of information materials for persons with print disability?
  • What kind of information materials do you plan to produce? (e.g. text books, novels, comic, etc) _______________________________________________________
  • How many staff can be allocated to produce such materials? ____________
  • How many computers can be allocated for this production? ________________________
  • Do you have any plan to produce such materials in digital format (DAISY)? _______________________________________________________
  • Do you think training is necessary for the production of such material in digital format (DAISY)? If so, why? __________________________________________________ ____________________________________________________________________ ____________________________________________________________________
• Q3. Please evaluate your technical skill below.
  • Do you use computer for your daily work? (e.g. MS Word, Excel, Power Point, Internet, email, HTML/CSS editor, Photoshop, Sound editor, Movie editor, etc) *Please write software you can use.
  • Have you ever make website by yourself? (Please indicate URL if you have uploaded)
  • How much do you know about the following term?
    • HTML =
    • CSS =
    • SMIL =
    • MP3 =
  • Have you ever learned about production of digital (DAISY) book?

Definition of Persons with Print Disability

According to a website of DAISY Consortium, a print disability is summarized as:

The definition of a print disability can vary from country to country but generally, it may be defined as the inability to access print due to visual, perceptual, or physical disability, e.g., blindness, learning disability or inability to hold a book.
(Please refer: http://www.daisy.org/about_us/g_faq.asp#a_24)

A website of Queensland Narrating Service provides a more detailed explanation of a print disability as follows:

People with a print disability are those who cannot obtain access to information in a print format because they:

• are blind or vision impaired, or
• have physical disabilities which limit their ability to hold or manipulate information in a printed form, or
• have perceptual or other disabilities which limit their ability to follow a line of print or which affect their concentration, or
• cannot comprehend information in a print format due to insufficient literacy or language skills.

(Please refer: http://www.connectqld.org.au/asp/index.asp?pgid=15141&cid=30063&id=53827