Tactile Image Interest Form

Organization Information

Organization NameOrganization Nametrue

Art MuseumHistoryfalseNatural History MuseumtrueSciencefalsefalsefalseOtherChildren's MuseumNatural HistoryArtLibraryPlanetarium or ObservatoryPlanetarium or ObservatoryChildren'sfalseNature Center or ParkotherLibraryAquarium, Botanical Garden, or Zoofalse10Organization TypesfalsefalseHistory MuseumNature Center or ParkScience/Technology Center or MuseumOrganization TypeAquarium, Botanical Garden, or Zoofalsefalsefalse

falseOther Organization TypeotherfalseShow1Organization Typefalse

Other Organization TypeOther Organization TypeEnter your organization typeothertrue

Organization Annual AttendanceOrganization Annual Attendancetruenumeric

Large City (>250,000)suburbansmall cityruralMid-sized City (100,00-250,000)falsefalse5Organization SettingfalsefalsefalsefalseSuburbanSmall City (<100,000)large cityRuralOrganization Settingmid-sized citytrue

For-profitothergovernmentNon-profitfalsefalse4Is the Organization a for-profit, non-profit, or government agency?falsefalsefalseOtherGovernmentfor-profitNon-Profitnon-profittrue

falseOther Organization StatusotherfalseShow1Non-Profitfalse

Other Organization StatusOther Organization StatusEnter your organization's statustrue

Point of ContactPoint of Contacttrue

Point of Contact's Job TitleJob Titletrue

Point of Contact's Email AddressEmail Addresstrueemail

Mailing Address

Please include the mailing address the panel should be shipped to if your organization is picked to receive one.

Street AddressStreet Addresstrue

Street Address 2Street Address 2

CityCitytrue

falsemediumFieldPuerto RicoSDWashingtonWYfalsefalseGUMDfalsefalseNJPRtruefalseWAWyomingDistrict of ColumbiaNorth CarolinaSouth DakotaVIOHMinnesotaMNMTILGuamMarylandNew JerseyNCfalseMontanafalseARfalseAlaskafalseUS Virgin IslandsfalsefalsefalsefalseAKfalseIAAlabamaTXfalseMichiganNew YorkNMMAfalseFloridafalseOregonVermontALCTIowaTexasfalsefalseFLfalsefalseConnecticutORVTGAMassachusettsTNKSColoradofalsefalseKansasfalsefalsefalseCOGeorgiaVAfalseVirginiaNYTennesseeNEOklahomafalseKentuckyNebraskaUtahfalsefalseCaliforniafalseDEfalsefalseAmerican SamoafalseCAfalseNew MexicoNDfalseHawaiiINMEWest VirginiafalsefalseNorth DakotaOKfalseMaineMIDelawarePennsylvaniaPASCStatefalseIndianaKYfalseIdahoAZSouth CarolinafalseWisconsinfalseMOMPNevadaLouisianaRIHIfalsefalseWVArkansasMissouriNorthern Mariana IslandsfalsefalseLANVfalseMSRhode IslandfalseASfalseIllinoisNHDC56State, district, or territoryOhiofalseArizonaIDfalsefalsefalsefalseNew HampshireWIfalseMississippiUT

Zip CodeZip Codetruenumeric

Other Questions

mediumFieldfalseIntended Use0Intended Use or Description of Audience Need (approximately 50 words)4true

When do you anticipate first being able to use the panel?First Usetrue

falsefalseNonoWill Provide FeedbackyestrueYes2Do you agree to provide information via email about your experience with the panel within two weeks of your first use? (approximately 100-200 words)false

Emails to Receive ConfirmationConfirmation RecipientsYou will need to enter your email again to receive a copy of your responses. You may enter multiple emails.