Enroll FacebookThis field is for validation purposes and should be left unchanged.Enrollment Registration FormBefore participating in National Digital Equity Center classes and programs, you must first complete this one-time Enrollment Registration Form. If you need assistance with completing this form or registering for our classes and programs, please contact us at (207) 259-5010 and leave a message with your name, phone number, and the best time to return your call. Maine residents participate in our classes for free. Please indicate below if you are a Maine resident, or must pay for a class.Maine ResidentNeed to pay the out-of-state class feeIf you need to pay the out-of-state class fee, please contact info@digitalequitycenter.orgContact InformationName(Required) First Last Business Name (if applicable)Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code County(Required)Please select your county. If you do not live in Maine, select "Not in Maine"CountyAndroscogginAroostookCumberlandFranklinHancockKennebecKnoxLincolnOxfordPenobscotPiscataquisSagadahocSomersetWaldoWashingtonYorkDon't KnowNot in MaineEmail(Required) Will accept contact via email Yes Preferred Phone(Required)Preferred Phone TypeMobileLandlinePhone Questions Will accept contact via phone Will accept TXT messages on this Alternate PhoneAlternate Phone TypeMobileLandlineBackground InformationTHE FOLLOWING QUESTIONS ARE REQUIRED SOLELY TO ALIGN TO NATIONAL DATA STATISTICS SUCH AS CENSUS DATA IN ORDER FOR US TO CORRELATE OUR PROGRAM IMPACT TO THE NATIONAL AND LOCAL NEED. ALL ANSWERS ARE CONFIDENTIAL AND SECURE AND NEVER WILL WE SHARE YOUR PERSONAL INFORMATION OUTSIDE OF THIS PROGRAM.Education Level(Required)Less than HS/GEDHigh School/GEDAssociateBachelorGraduateEmployment Status(Required)UnemployedEmployed PTEmployed FTRetiredStudentDomestic (stay at home)Gender(Required)MaleFemaleOtherAge Range(Required)17 years or younger18-2021-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485 years and overRace(Required)WhiteBlackHispanicAsianHawaiian/Pacific IslanderAmerican Indian/AlaskanOtherPrefer not to AnswerOther Information Am a Veteran Am Disabled Am a parent/guardian (school age child) Single Parent Household English is my second language (ESL) Yearly Household Income ($)(Required)Less than $10,000$10,000 to $14,999$15,000 to $24,999$25,000 to $34,999$35,000 to $49,999$50,000 to $74,999$75,000 to $99,999$100,000 to $149,999$150,000 to $199,999$200,000 or morePrefer not to answerHousehold Size(Required)Please enter a number from 1 to 100.Are you participating in this class for work?YesNoAre you theEmployerEmployeeAre you a student?YesNoHome Internet Type(Required)DSLCableSatelliteWirelessFiberCommunity Wi-FiOtherDon't KnowNoneHave the following: Desktop computer Laptop computer Tablet Smartphone None I am interested in taking classes because: I want to improve my job skills I‘m here at the request of my employer I want to improve my ability to manage my health/healthcare I want to improve my ability to support my school-aged child I have plans to further my education and need to improve my technology skills I want to manage my social services online I want to improve my ability to find and use online information I want to manage my finances/banking online I want to improve my technology skills for personal reasons I describe my computer skill level as: (select only one) I am new to computers I have a little experience with computers but generally need help to operate them I have some experience with computers and can navigate basic functions but still need help with computers programs/software applications I am experienced on computers and am able to do most things I need/want to but I want to learn more I am an advanced computer user and have no problem operating computers Finally, please let us know in the space below who referred you to the National Digital Equity Center, specifically if you were referred by a specific organization (adult ed, library, other nonprofit).This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. Δ
