2019 TGH CHA New Site Application
Please complete the entire application. If you have questions, contact Sammy Lowdermilk at sammy@techgoeshomecha.org.

Completing this application does not guarantee approval to run a course.

Your Name *
Your answer
Your Email *
Your answer
Your Telephone Number *
(xxx) xxx-xxxx
Your answer
Your Title/Position (at the institution/community organization) *
Your answer
Training Site & Course Info
Course Location *
Please include the full name of the site or organization where the course will be held.
Your answer
Classroom Location *
Room #, Street Address, City, Zip
Your answer
Do you have a classroom/lab with computers available at your location? *
Please note: Having a computer lab is not a requirement to run a TGH CHA course.
How many fully functional computers do you have in the classroom? *
Your answer
Are the computers available for use during the course desktops or laptops? *
Do you have wifi available in your classroom? *
Which type of TGH CHA course would you like to offer? *
Required
Do you already know who would be the TGH CHA trainer(s) at your site? *
Please note: TGH CHA provides training for the course trainers, materials & resources. We do NOT provide trainers.
If yes, what is her/his name AND email address?
Your answer
Has he/she been a TGH CHA trainer in the past? *
Number of participants or student/caregiver pairs your site will accommodate *
This is generally limited by the number of computers available. Please limit School courses to no more than 20 student/caregiver pairs and Community/Early Childhood courses to 15 or less.
Your answer
Population Being Served *
Please select all that apply. If you are teaching a course to families that speak languages other than English or Spanish, please select "Other" and enter the language(s). If you are uncertain at this time, please make an educated guess.
Required
Language(s) in which course will be taught *
Check all that apply.
Required
What age(s) will you be teaching? *
You can check more than one. If you are uncertain at this time, please make an educated guess and also check TBD.
Required
Do you offer existing programs at your site (after school tutoring, daycare, free meals, etc.) that serve this population? *
If yes, please briefly describe those programs and number of participants in a typical period (week/month/year/summer).
Your answer
Please indicate ALL sessions in which you would like to offer a TGH CHA course. *
This will help us evaluate our distribution and we may be able to approve your site for a future session (if you are not approved for the next upcoming session).
Required
Anything else you would like us to know?
Your answer
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