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Digital Bridges 50+ Application
1.
Name
2.
Address
*
3.
Phone Number
(Required.)
*
4.
Email
(Required.)
*
5.
Date of Birth
(Required.)
6.
Household size
7.
Annual Household income
8.
In order to receive a laptop participates
must
attend 4 training sessions and attend a city council meeting in December. Do you think that you can make this commitment?
Yes
No
9.
What sites are you able to attend?
Gil Carter Initiate
Topeka & Shawnee County Public Library
10.
Do you already have a device
Yes
No
if so, what kind do you use.
11.
What is your comfort level with using a laptop
5 - Very Comfortable
4
3
2
1 - Not Comfortable at all