IDEAL Assistive Technology (AT) SmartDrive Problem Reporting Form

This is the first part of a two-part form. The second part of this form will display upon clicking the "Submit" button at the bottom of this form. In order to resolve the assistive technology problem you are experiencing you will need to complete both parts of this form. Thank you for helping us enhance the quality of the applications you are using. We sincerely appreciate your efforts.

1.

First Name: *

2.

Last Name: *

3.

E-Mail Address: *

4.

Daytime Phone Number (Including Area Code): *

5.

Please select ALL of the applications you were using when you experienced a problem using your assistive technology:

6.

Other: Please list any applications you were using (at the time you experienced a problem) that are not listed in the question above.

7.

Please describe exactly what you were doing immediately before experiencing the problem. Also describe what happened to make you aware that a problem occurred. For example, "my system locked up." "funny characters started appearing on the screen." "spaces started to appear when I was typing words." etc.

8.

Please enter the wording of the error message(s) you received notifying you that there is a problem.

* = Input is required