Name
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First Name
Last Name
Email Address
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Phone Number
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(###)
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City and State
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Gender Expression
Date of Birth
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Education, including degree(s) and year(s)
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For example: Bachelors Degree from Rice University, 20XX
Work history, including year(s)
Emergency Contact
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First Name
Last Name
Relationship to Emergency Contact
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Emergency Contact Phone
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(###)
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Emergency Contact Email
What is your visual acuity? How long have you been blind or visually impaired?
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Do you have experience with a PC, a Mac, or other adaptive technology equipment?
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How long have you been using iOS devices?
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What iOS or other Apple devices do you own or have access to in your home?
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Do you have access to a stable Wi-Fi connection?
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Do you have access to an alternative method of communication?
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For example, do you have a landline, access to another cell phone, a computer or iPad with Zoom or Skype, or a smart speaker? Please explain.
What is your Apple ID?
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Which of the following objectives can you perform using VoiceOver, not the built-in assistant Siri?
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Check all that apply
What are the apps you use on a regular basis?
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Do you have experience providing assistive technology training, either formal or informal? If so, explain what devices and for how long.
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What apps do you recommend for a new user?
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Are you a registered member of iBUG?
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For example, are you on our mailing list?
How much time do you have available per week to participate as a mentor?
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When could you meet with your mentor?
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Check all that apply
Please acknowledge the following statements to indicate that you have read and understood them.
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a. Prior to being accepted as a mentor in the iBUG JumpStart Mentoring Program, I will be expected to participate on the iBUG Buzz Conference held on the Zoom platform on Monday nights from 7:00 to 9:00 PM (Central Time) for a period of two months. During that time, I understand that I must participate fully in the call by answering and making comments on questions posed by callers. iBUG may determine that the two-month period can be shortened based on my prior work history, experience doing demonstrations at iBUG training sessions, or participation in other assistive technology programs.
b. The iBUG Jumpstart Mentoring Program provides basic training on iOS devices, applications, gestures, and features.
c. The iBUG Jumpstart Mentoring Program provides training on the use of VoiceOver exclusively.
d. I must instruct my mentee to turn on the screen curtain and use VoiceOver exclusively.
e. I must give clear homework assignments and recommended reading assignments, and assess whether they were completed.
f. Failing to complete the status report for my mentee on a regular basis will result in removal from the iBUG JumpStart Mentoring Program.
g. Cancelling or rescheduling on two or more occasions without just cause may result in removal from the iBUG JumpStart Mentoring Program.
h. I must attend and participate in the quarterly and special iBUG JumpStart Mentoring Program meetings.
i. iBUG is committed to providing instruction on the objectives identified above exclusively.
j. I will not be providing instruction on other built-in or third-party applications not identified above.
k. The iBUG JumpStart Mentoring Program consists of twelve two-hour training sessions. Furthermore, my mentee and I will decide if we have a single two-hour session or two one-hour sessions per week. All training sessions must be completed within 4 months from the start of the mentoring program.
l. It is my responsibility to advise the iBUG JumpStart Coordinator if my mentee or I need to temporarily stop mentoring sessions due to illness or other unforeseen circumstances. A prolonged break of more than one month may result in reassignment to a new mentor.
m. I will determine when my mentee is ready to move on to the next objective.
n. I will test my mentee to prove that he/she has learned an objective.
o. The iBUG JumpStart Mentoring Program will last until the mentee has learned all twelve tasks/objectives or twelve sessions, whichever occurs first.
p. It is my mentee's responsibility to work diligently to learn all twelve tasks/objectives, and even if he/she does not complete them all for any reason, there will be no extension of the twelve-session program.
q. It is my mentee's responsibility to advise me if he/she upgrades their iPhone. Furthermore, it may be necessary to reassign my mentee to a different mentor.
r. iBUG Today reserves the right to alter, reassign, or remove my mentee assignment.
s. After my mentee completes the iBUG JumpStart Mentoring Program, he/she cannot contact me for ongoing help, and they will participate in the iBUG Buzz Conference on Monday nights to obtain help.
t. I will maintain and submit the iBUG JumpStart Mentoring Program Status Report after the fourth, eighth, and twelfth sessions. I will send the report to jumpstart.ibugtoday@gmail.com.
u. It is my responsibility to keep the iBUG JumpStart Mentoring Program Coordinator apprised of any change in my contact information or availability to serve as a mentor.
I have read and accept all the provisions of the foregoing iBUG JumpStart Mentoring Program Waiver Form.
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I verify all of the above information is correct and true to the best of my knowledge.
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Type your full name to represent your signature on this application form.
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Date of Execution
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