Register - Intopia Connect

You are on your way to getting connected with Intopia Connect!

Please note you must be over 18 and live in Australia or New Zealand to register with us.

All fields are mandatory unless marked (optional)

Personal details

First Name

Last Name

Also known as (optional)

Nickname or your full name if you have a different name

Email

Phone

Please provide your phone number so that we can contact you.

I identify my gender as:

The term I use is...

Pronouns (optional)

Please provide the pronoun(s) you identify with such as She/her, He/him, They/them

Year of birth (YYYY)

Please enter a number from 1900 to 2004. We sometimes get asked to find participants who are within a set age range which is why we are asking this question.

Contact details

Prefer to be contacted by: (optional)

Phone - call

Phone - text message

Email

Location

I live in

Postcode (optional)

Please enter a number from 0001 to 9999. If you don't know your postcode, visit AusPost - Find a postcode (Opens in new window) or NZ Post- Find a postcode (Opens in new window), or skip this for now and we'll get in touch to find out about your area.

Language

Is English your first language?

Yes

No

Please tell us your first language:

Disability

Ability

I have a disability or impairment

I do not have a disability or impairment

I am interested in Connect because (optional)

I have the following disability at least in some contexts (select all that apply):

Sensory - for example, difficulty seeing, hearing, perceiving colour, text or numbers

Physical - for example, difficulty walking, moving, grasping or reaching

Intellectual or cognitive - for example, Down Syndrome, Aphasia, difficulty concentrating, remembering or communicating

Neurodivergent - for example, ADHD, ASD or Dyslexia

Mental or psychosocial - for example, depression, PTSD, anxiety or schizophrenia

Chronic condition or illness - for example, asthma, cancer or epilepsy

Other - or I would rather not specify - let's talk

You have selected sensory disability, please specify (optional)

Blindness

Colour blindness

Deaf

Deafblindness

Hard of hearing

Low vision

Sensory hypersensitivity (e.g. sensitive to certain smells, lights or noises)

You have selected physical, please specify (optional)

Dexterity issues, tremors or arthritis

Difficulty grasping or reaching

Difficulty moving hands or legs

Difficulty or unable to climb stairs

Difficulty walking distances

Skin or dermatological difference or albinism

Small stature/ little person

You have selected intellectual or cognitive impairment, please specify (optional)

Aphasia

Cognitive impairment

Difficulty concentrating

Difficulty communicating

Difficulty reading and writing

Difficulty with memory (short term or long term)

Down Syndrome

You have selected neurodivergent, please specify (optional)

ADHD

Autism

Dyscalculia

Dyslexia

Dyspraxia

Dysgraphia

You have selected mental or psychosocial, please specify (optional)

Anxiety

Depression

PTSD

Schizophrenia

You have selected chronic condition or illness, please specify (optional)

Asthma

Cancer

Chronic fatigue syndrome

Chronic pain

Congenital or other heart disease

Diabetes

Epilepsy or seizures

Multiple Sclerosis

You have selected other or let's talk (optional)

Technology usage

I often use the following devices (optional) Select all technology or assistive devices that you use (if applicable) Other assistive devices or support? (Optional) Please select all that apply.

Availability

How do you usually spend your time (please select all that apply)

Work - Full-time

Work - Part-time, flexible or casual hours

Study - Part-time, flexible or casual hours

Caring, assistant or parenting responsibilities

Volunteer or looking for new opportunities

It depends

I'm happy to travel locally to take part in usability testing (optional)

Yes - I'm happy to travel

No - I am only interested in home-based or online opportunities

It depends

How did you find out about Intopia Connect? (optional)

Letting us know how you found out about us helps us to pass on our thanks (it is helpful for us and optional for you)

Anything else you'd like to tell us? (optional)

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