NDEC Digital Navigator Tracking Form - National Digital Equity Center

Please enter this information for each participant in an Applying for the ACP class or outreach event. If you are not using Ditto to track your digital navigator one-on-one sessions for ACP enrollment, please use this form to track that information here as well.

Digital Navigator Name

Digital Navigator Program (Please select your organization from the dropdown)

Was this a Digital Navigator Session, Applying for the ACP Class, or ACP Outreach Event (Please select one from the dropdown choices)?

Date

Location/partner onsite where the event/class/session was held:

Zipcode of the town in which the event was held:

County in which the event was held:

How many people attended this session or event or how many flyers did you distribute?

Of those who attended this session or event, how many participated in a discussion about the ACP?

For outreach events, this includes listening to what the ACP is and how to apply and/or completing the survey tracking form. For DN sessions and the Applying for the ACP class, please enter the same number as the first question above.

Of those who attended, how many do not currently have an internet connection at home?

Of those who don't have internet at home, how many access the internet ONLY through their cell phone?

Of those who attended, how many were enrolled in the ACP at the start of the session or event?

Of those who attended, how many were enrolled in the ACP at the completion of the session or event?

Of those who attended, how many plan to enrolled in the ACP on their own based on what they have learned from the session or event?

Of those who attended, how many requested assistance with ACP enrollment by completing a Digital Navigator Referral Form or an ACP Issue Ticket?

Notes to NDEC (please enter below anything else you would like us to know about this event, class, or session)).