Computer Skills Survey

1. Please select which category best describes you.

Please select which category best describes you. I am an individual with a disability (completing independently or with assistance).

I am a family member of an individual with disability.

I work with individuals with disabilities.

Other (please specify)

2. Where do you use computers at? (Select all that apply)

Where do you use computers at? (Select all that apply) Home

Work

Library

Other (please specify)

3. What makes the computer difficult for you to use?

What makes the computer difficult for you to use? No training/classes Hard to see Hard to hear	Using the mouse Typing on the keyboard Reading
Other (please specify)

4. Please select all the statements that describe your experiences with computer classes.

Please select all the statements that describe your experiences with computer classes. I have never taken one.

Cost of classes are too expensive.

Transportation is difficult.

Times offered are not convenient.

There are too many people.

I can't ask questions.

The teacher goes too fast for me to keep up.

I have taken computer classes on:

5. Which computer skills would you like to learn?(Select all that apply)

Which computer skills would you like to learn?(Select all that apply) Basic Computer Information (Parts of the computer, using the operating system, Windows) Typing Word Processing (Microsoft Word) Spreadsheet (Excel) Database (Access) Creating printed material (Publisher, signs, cards)	Surfing the Internet E-mailing Social networking (Facebook, MySpace) Playing on-line games Shopping
Other (please specify)

6. Project ACT (Accessible Computer Training) hopes to provide individuals with access to computers and trainings.

Please select each item you would like additional information about.

Project ACT (Accessible Computer Training) hopes to provide individuals with access to computers and trainings. Please select each item you would like additional information about. Computer access in my community

Getting a re-utilized computer for my home

On-line training

One-on-one training

DVD trainings

Other (please specify)

7. Please complete the information below so that Project ACT can assist you directly.

Please complete the information below so that Project ACT can assist you directly. Name:
Address:
Address 2:
City/Town:
State:
ZIP/Postal Code:
Email Address:
Phone Number:

Computer Skills

1. Computer Skills

1. Please select which category best describes you.

2. Where do you use computers at? (Select all that apply)

3. What makes the computer difficult for you to use?

4. Please select all the statements that describe your experiences with computer classes.

5. Which computer skills would you like to learn?(Select all that apply)

6. Project ACT (Accessible Computer Training) hopes to provide individuals with access to computers and trainings. Please select each item you would like additional information about.

7. Please complete the information below so that Project ACT can assist you directly.

6. Project ACT (Accessible Computer Training) hopes to provide individuals with access to computers and trainings.

Please select each item you would like additional information about.