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* 1. First Name

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* 2. Last Name

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* 3. Email address

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* 4. Gender

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* 5. Date of Birth (MM/DD/YYYY)

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* 6. With which group do you most identify?
You may select more than one option.

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* 7. What is your age?

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* 8. What is your highest educational level? 

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* 9. What is your employment status?

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* 10. What is your approximate annual household income?

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* 11. How many members are in your household (including yourself)?

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* 12. Do you have school-aged children in your household?

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* 13. Have you participated in any Tech Goes Home class before?

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* 14. Have you taken any digital skills class before (other than Tech Goes Home)?

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* 15. Why did you decide to participate in Tech Goes Home?
You can select more than one answer.

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* 16. Which devices do you use at home?
You may select more than one option.

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* 17. How many internet-capable devices do you have at home? (For example: cell phone, tablet, desktop computer, laptop computer, Kindle, smart TV, etc.)

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* 18. How confident are using a computer and the internet?

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* 19. How do you access the Internet in your home?
You may select more than one option.

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* 20. Have you ever changed or cancelled your Internet subscription (wi-fi or mobile data) because it was too expensive?

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* 21. What do you hope to learn in this class?

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* 22. I hereby give the unqualified right to the Tech Goes Home Tennessee (TGH TN) program and to TGH TN partner organizations (like the senior centers and community organizations hosting the classes and non-profits funding the classes) to take pictures and/or video of me during the class. I give permission for these images as well as materials that we have created in the TGH TN program to be used in print and web-based publications. The TGH TN program and our partners will put these images to legitimate use without limitation or reservation.

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