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1. Which device(s) are you interested in learning more about?

Computer

Tablet

Smartphone

I’m not sure

2. Which of the following do you feel confident using?

Keyboard

Touchscreen

Mouse

3 Have you used the internet before?

Yes

4. Do you have an email address? (which you have access to)

Yes

Yes, but I’m not sure how to use

5. Have you ever completed a form online?

Yes

Not Sure

6. Have you ever used a search engine to find the information you need online?

Yes

7. Do you feel confident using a computer to create documents?

Yes

8. Do you want to learn more about how to stay safe online?

Yes

Name

Contact Number

Local Centre

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Note: Please fill out the fields marked with an asterisk.

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