Tech Help Interest Form: Better At Home/FolkU
This form helps us understand what kind of tech help you’re looking for, how to best support you, and collects some basic personal information. We ask for your name and contact info so we can get in touch with you, but it will never be shared with funders or attached to any reports.
Sign in to Google to save your progress. Learn more
Your name: *
Best way to contact you: *
Phone number:
Email address: *
What's your address? *
Gender: *
Do you identify as Indigenous? *
Is English your second language? *
Employment status: *
Do you feel comfortable using technology now? *
What devices do you want help with? (Check all that apply) *
Required
What tasks would you most like help with? (Check all that apply) *
Required
What do we need to know before coming to your home? For example, do you need vision, hearing, mobility, or memory support? Does getting to your house require special directions or a 4x4-only driveway? *
Are you comfortable with us keeping simple notes about what you work on, so we can improve and continue this free program?
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms