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Digital Bridges 50+ Application
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1.
Name
(Required.)
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2.
Address
(Required.)
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3.
Phone Number
(Required.)
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4.
Email
(Required.)
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5.
Date of Birth
(Required.)
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6.
Household size
(Required.)
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7.
Annual Household income
(Required.)
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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?
(Required.)
Yes
No
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9.
What sites are you able to attend?
(Required.)
Gil Carter Initiative
Topeka & Shawnee County Public Library
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10.
Do you already have a device
(Required.)
Yes
No
if so, what kind do you use.
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11.
What is your comfort level with using a laptop
(Required.)
5 - Very Comfortable
4
3
2
1 - Not Comfortable at all