Research Participant Application – udpkenya

Fill the participant application form for participating in a research for Assistive Devices

FILL THE APLICATION FORM

Name *

First

Last

Email Address

Phone Number *

Which County are you from or based in kenya

Are you a person with a disability

Yes
No

If yes to the above question,What type of disability do you have

Do you use any Assistive Device

Yes
No

If yes to the above question, What type of Assistive Device do you use

Click to Select your Age Range from the box below

What is you preferred method of communication

Name

Accessibility by WAH