Digital Navigation

Name(Required)

First Last

Prefered method of contact(Required)

Phone call

Text message

Other

Preferred method of contact (Phone or Email)(Required)

Pronouns(Required)

What language(s) are you comfortable communicating in?(Required)

Preferred days & times to meet (e.g. Mondays before noon, etc.)(Required)

How did you hear about this program?(Required)

Friend/Family

Organization website

Internal referral (e.g., front desk, other staff at this organization)

External referral (e.g., partner organization)

Advertising/marketing (e.g., ﬂier, online ad, commercial)

What Types of technology supports will you need to complete this training(Check all that apply)(Required)

Need a device

Support using devices

Home internet connectivity

Digital Skills

None

What outcome are you looking to gain after completing this training(Required)

Communication/ Social

Education (Formal or informal)

Job search (including resume& online applications)

Work and Business (including small business, entrepreneurship, and learning new job skills)

Entertainment & Hobbies

Access and Manage Services and Beneﬁts (e.g. submit taxes, apply for

Shopping (online or research for in-person shopping)

Prefer not to say

Type of Device – What type of device do you need help with? (select all that apply) *(Required)

Smartphone

Tablet

Chromebook

Laptop

Desktop

I do not have a device

Digital Navigation Interest Form