Digital Skills Form

First name

Last name

Address

City

State

Zip

Email

Cell or Mobile Phone

Job Title

Age
50-5455-5960-6465-6970-7475-7980+Prefer not to say

Gender
FemaleMalePrefer not to sayPrefer to self describe

Highest Level of Education
No High School Diploma/GEDHigh School DiplomaSome CollegeTechnical College DegreeAssociate's DegreeBachelor's DegreePostgraduate Degree

Are you of Hispanic, Latino, or Spanish origin or descent?
NoYesPrefer not to say

Race
American Indian or Alaskan NativeAsianBlack or African AmericanCaucasian (White)Native Hawaiian or Other Pacific IslanderMulti-racialWhite (non-Hispanic/Latino)Prefer not to sayPrefer to self-describe:

What is your current employment status?
Employed part timeEmployed full-timeUnemployedSelf-employedPrefer not to say

How many people including yourself are part of your household?

What was your household income last year?
$32,000 or less$32,001-$43,000$43,001-$54,000$54,001-$66,000More than $66,000

Do you currently have internet access at home?
YesNoNot sure

Generally, how often do you use the internet on a digital service?
DailyA few times a weekMonthly or less oftenI don't access the internet

How comfortable are you with using a smart phone?
Not comfortableSlightly comfortableModerately comfortableVery comfortable

How comfortable are you with using a computer/laptop/tablet?
Not comfortableSlightly comfortableModerately comfortableVery comfortable

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Cloud StorageFinding Information OnlineGetting Started with ZOOMGoogle MapsGmail (email) Tips & TricksVideo Chat