Untitled 1

Citizens With Disabilities - Ontario (CWDO)
Prototype created by Asif Patel for CWDO. 25 Jan 2017 asif_patel@outlook.com
DATABASE ENTRY FORM QUESTIONNAIRE
Source: SQL Database

Click here to go Database Query/Search Form

1. Member Contact info:

Unique membership number
Date joined (month/year)
Members' names
Members' addresses (Apartment number, city, province = Ontario (default), postal code)
Members' phone number, TTY phone number, cell phone number
Members' email addresses (personal, work, other)
Date membership ceased (inactive)

2. Members' Electoral Ridings

Municipal riding

Provincial riding

Federal riding

3. Newsletter subscriptions

4. Members' Preferred Formats

5. Members' Interests

6. Members' Disability Status

I have a disability

I am close to someone who has a disability

7. Members' Experience of Disability

8. Type of membership

Individual

Association (specify in comment box below)

Club (specify in comment box below)

Organization (specify in comment box below)

Disability related business (specify in comment box below)

9. Skill Sets

10. How Member Learned about CWDO?

11. Members' Statement of Goals: What would you like to accomplish as a member of CWDO?