National Digital Equity Center

Partnering To Create Disruptive Strategies To Close The Digital Divide Across the United States

Email (207) 259-5010

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Enrollment Registration Form
By completing this form, you are enrolling in the Maine Digital Inclusion Initiative, a program that provides free computer skills classes and tutoring to Maine residents. Out-of-state residents can access this program for $50/year.
If this registration is part of a specific organization, adult education or library program, please enter the name of that organization or program here. We share your contact information and classes attended with the organization you enter below, but we do not share any of your individual confidential information.
Contact Information
Name*
First Last
Business Name (if applicable)
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Will accept contact via email
- Yes
Preferred Phone*
Preferred Phone Type
Phone Questions
- Will accept contact via phone
- Will accept TXT messages on this
Alternate Phone
Alternate Phone Type
Background Information
THE FOLLOWING QUESTIONS ARE REQUIRED SOLELY TO ALIGN TO NATIONAL DATA STATISTICS SUCH AS CENSUS DATA IN ORDER FOR US TO CORRELATE OUR PROGRAM IMPACT TO THE NATIONAL AND LOCAL NEED. ALL ANSWERS ARE CONFIDENTIAL AND SECURE AND NEVER WILL WE SHARE YOUR PERSONAL INFORMATION OUTSIDE OF THIS PROGRAM.
Education Level*
Employment Status*
Gender*
Age Range*
Race*
Other Information
- Am a Veteran
- Am Disabled
- Am a parent/guardian (school age child)
- Single Parent Household
- English is my second language (ESL)
Yearly Household Income ($)*
Household Size*
Please enter a number from 1 to 100.
Are you participating in this class for work?
Are you the
Are you a student?
Home Internet Type*
Have 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
How did you hear about the National Digital Equity Center?
- Word of mouth
- Facebook or other social media
- Google search result
- Ad on TV
- Newspaper Ad
- NDEC Tablet Program
- NDEC Volunteer Online Tutor Program
- Presentation/Webinar about NDEC
- Other (not listed above)
Please check as many as apply.
Other (please describe)
Finally, if you are not a Maine Resident, click here to arrange payment of your $50/year subscription.
Comments
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