Survey on the analysis of target group needs in terms of cognitive challenges, skills and learning needs

I provide my explicit consent for: *

YesNo
My participation in the aforementioned study and for the subsequent processing of the data and information I provide, as above described:
My email and other contact details I will provide to be kept so that you will be able to contact me and inform me of the progress of the project and future activities:
My email and other contact details I will provide to be kept so that you will be able to contact me and inform me of other projects you participate in, which are relevant to my line of business and profile:

Email address (optional):

Gender *

Age: *


Do you face any health-related challenge(s)? *

I face the following health-related challenges:

If other, please specify what kind of physical challenges?

For each type of digital devices listed below, please, choose the frequency you use them: *

Every dayFew times per weekFew times per monthNever
Mobile phone
Smart phone (phone with touch screen)
Tablet
Laptop
e-Reader
Home PC

Memory Capacities *

NoI have difficulties very oftenI have difficulties sometimesYesI don't know
I find it easy to remember everyday things
I usually remember where I put my personal items (keys, phone, documents, etc.)
I usually remember events (important dates) or other information from the past
I find it easy to remember things planned for the future (appointments, shopping list, taking drugs, etc.)

Attention Capacities *

NoI have difficulties very oftenI have difficulties sometimesYesI don't know
I stay focused on task despite distractions
I stay focused on task for a sustained period of time (e.g. reading a long text)
I find it easy to do two things at the same time
I find it easy to stay concentrated when driving

Visual Perception Capacities *

NoI have difficulties very oftenI have difficulties sometimesYesI don't know
When I think about something, I can visualize it in images or scenarios
I can easily interpret maps
I can easily organize and interpret diagrams or charts

Reasoning and Planning Capacities *

NoI have difficulties very oftenI have difficulties sometimesYesI don't know
I find it easy to reason and form ideas
I find it easy to solve problems
I can easily plan or organize something for a specific topic

Processing Speed Capacities *

NoI have difficulties very oftenI have difficulties sometimesYesI don't know
I calculate my shopping bill quickly and accurately
I can react quickly and adapt to the environment
I can solve simple math problems in my head

Sequential Processing Capacities *

NoI have difficulties very oftenI have difficulties sometimesYesI don't know
I can put things in order when thinking
It is easy for me to plan activities and events step by step

Please, rate the importance of each statement: *

Not importantMaybe it’s usefulIt’s importantVery important
I find it easy to use my smart phone
I can read the newspapers on the Internet
I use my email to communicate with my family members or friends
I use tools like Skype, Messenger, etc. to communicate with family and friends
I use Facebook, Twitter, Instagram or other social media
I use my phone/tablet/PC to edit photos & videos and save them for future reference
I use my devices to submit my Tax declaration or other governmental declarations through the Internet
I shop through the Internet
I check the status of my bank account through the Internet
I manage my electronic health record or I consult my health insurance through the Internet

Please, rate the appropriateness of the methods below, to learn new technologies: *

NoI don’t knowIt’s a good ideaYes
I find it easier to learn during face-to-face group lessons.
I find it easier to learn during face-to-face private lesson.
I find it easier to attend courses through the Internet.
I like learning through face to face classes combined with Internet sources.
I find it easier to learn by interaction with family members or friends.
I find it easier to learn from peers.

During my free time I like: *

YesNo
Playing mind games (Sudoku, crosswords, etc.)
Playing board games (Scrabble, cards, Monopoly, etc.)
Playing chess or backgammon
Learning new things via books, movies, performances, etc.
Going out with my friends and planning activities
If other, please specify: