Web-Based Products

Web-based products

*Response Required

*Program Type (Check all that apply):

FY15 NIRS Product Paper Form, Page 1 of 1

£  UCEDD

£  LEND

£  LEAH

£  PPC

£  DBP

£  SDHG

FY15 NIRS Product Paper Form, Page 1 of 1

*Fiscal Year: 2015

*Product ______

FY15 NIRS Product Paper Form, Page 1 of 1

*Date the product was developed ______

*Include(d) into DGIS/EHB export for ______

Type current FY for new product; type FY in the past if you are recreating the product for dissemination purposes.

*Type (select one)

FY15 NIRS Product Paper Form, Page 1 of 1

  Blogs

  Podcasts

  Web-based video clips

  RSS feeds

  News aggregators

  Social networking sites

  Other – please specify: ______

FY15 NIRS Product Paper Form, Page 1 of 1

*Target Audience (Check All the Apply)

FY15 NIRS Product Paper Form, Page 1 of 1

£  Consumers/Families

£  Professionals

£  Policymakers

£  Students

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*To obtain copies (URL or email) ______

APA Citation

______

______

Keyword 1 ______

Keyword 2 ______

Keyword 3 ______

Keyword 4 ______

Keyword 5 ______

Brief Description for AUCD NIRS Public Search (up to 1000 characters)

______

______

______

______

Alternative Formats (Check all that apply for alternative format(s) in which the product was actually disseminated)

FY15 NIRS Product Paper Form, Page 1 of 1

£  Captioned

£  Braille

£  Audio (cassette, audio file, etc.) Disk

£  Visual Format or Large Print

£  Web-site accessible (e.g. Section 508 Compliant)

£  Language other than English

FY15 NIRS Product Paper Form, Page 1 of 1

Ordering Information

Cost $______(Price/Unit; May use the format 99.99 but no commas are allowed)

Product Contact

Name ______

Address ______

Phone (999-999-9999) ______E-mail ______

FY15 NIRS Product Paper Form, Page 1 of 1