(Adapted from Donald Berman UP House)

Technology can be useful to keep people connected and participating in programs. However, technology can be challenging to use and may be a source of discomfort for some. This survey is to get to know what our community needs in order to participate in virtual/online programs.

The information you provide will only be seen by What Connects Us research staff and will remain confidential. You do not need to answer any questions you are not comfortable with.

Thank you for your participation! ☺
1. Select the organization(s) with whom you are affiliated with and/or if you use their services. Please scroll down and check as many that apply:
Other: Please click on the [Add]
2. We have been asked by the Public Health Agency of Canada to track the reach and impact of our initiative, can you please check as many as apply. I self-identify as,
3. Do you identify as a newcomer to Canada? (How long you and your family have been here)
*If the phone of the survey participant has no Internet, please write a note to notify the research team.
Personal only
Shared options
​​​​​​​Smartphone (What apps do you use, e.g., iPhone, Samsung, HTC, LG, etc.)
​​​​​​Flip phone
​​​​​​Desktop computer (What operating system?, e.g., Macintosh- Apple/Mac, PC-Windows, Linux, etc.)
​​​​​​Laptop computer (What operating system:, e.g., Macintosh- Apple/Mac, PC-Windows, Linux, etc.)
5. In the last week, which device have you used and how often have you used them?
Questions Never Very rarely Rarely Occasionally Frequently Very frequently Not currently using the device
6. Which of the following is/are NOT included with the device(s) you use? Check all that apply.
7. Are you interested in learning more about how to use your current device(s)?
8. If you could use any device what device would you use? What would you like to do with the device? (e.g., laptop computer, tablet, smartphone, other). Please click on the [Add] if you need more than one device
9. Which kinds of communication are you currently using? Check all that apply.
10. Would you like to learn about additional ways to communicate with others virtually* or online?
Questions Not a barrier Small barrier Big barrier Uncertain
Questions Beginner Intermediate Advanced Uncertain
13. If you were provided training, how would you like to receive training? Check all that apply.
Conversations option
Activities (enjoyment) options
Everyday life tasks option
Other: Please click on the [Add] if you need more than one activity
more items
16. What types of activities would you like to be involved in online?
Please enter your email or phone number here and a research team member will get back to you soon. 
Phone number: 
 This survey was created by Alexandra Bachand and Léa Marie Duguay, Fall 2020 M2 Occupational Therapy Students, McGill University with consultation from UP House staff, members, and volunteers. Thank you to Chesley Walsh, Suzanne Rouleau, Melissa Park, and Patricia Belchior for your help in creating this survey. It has been modified for use with the What connects us~Ce qui nous lie project