Cisco Academy for people who are blind or vision impaired
Application Form for admission to the Academy 
More information about the CAVI courses can be found at www.cavitraining.com

Please complete the form below by typing in the blank line below each numbered item, then return by email to: caviinfo@ciscovision.org

We ask these questions so we can serve you better. We do not use this information to discriminate against anyone. Your answers are kept private and are not shared outside of CAVI staff responsible for admissions.

An Academy instructor will contact you by phone or email to discuss your computer configuration and assistive technology skills prior to enrolment in the Academy.

1.	Which course are you interested in taking? Tell us a little about what you hope to get out of the course.

2.	Name

3.	Postal Address

4.	Home telephone number

5.	Mobile telephone number

6.	Timezone: 

7.	E-mail address

8.	Skype ID [if you have one]

9.	Gender

10.	Are you over 18?

11.	Highest completed school level

12.	Do you have any qualifications or certifications in your past or current industry?

13.	What is your current employment status?

14.	What is your preferred assistive technology program for accessing a computer?

15.	Please write a short paragraph about your level of computer experience. This helps us make sure our courses will work well for you. We want to know about things like: What programs do you use?  How long have you been using a computer?  How often do you use the computer?  Do you consider yourself comfortable on a computer?

16.	Do you have access to a computer running windows?  [This does not have to be your primary machine but most of the CAVI courses require you to be using windows.]

17.	Are you receiving assistance from any vocational counselling service or is your employer paying your fees?

18.	How did you hear about CAVI?

19.	Do you have any questions you would like addressed when you are contacted?

20.	Would you prefer to be contacted via Skype or telephone?

21.	What is the best time to contact you?

Thank you for your interest.
The CAVI team.