STRIVE WorldWIDE Pre-Registration & Technology Self-Assessment
This form will take approximately 15-20 minutes to complete.

Click on the following link to listen to the audio version of this message: http://bit.ly/audioSWW

Thank you for your interest in STRIVE WorldWIDE! STRIVE is a nonprofit organization based in South Portland, Maine. Over the past 20 years, STRIVE has provided social, educational, employment training and post-secondary educational opportunities for tweens, teens, and young adults with intellectual disabilities. STRIVE WorldWIDE offers online programming for independent living to individuals across the state, country, and worldwide! The purpose of STRIVE WorldWIDE is to further STRIVE's mission of providing opportunities for increased independence. It will provide training and skills building to a wider audience that would otherwise be unable to access STRIVE's programming.

This technology self-assessment is used to ensure that STRIVE WorldWIDE is a good fit for you. This should be completed by the participant (though support in completing it is welcome). This form will also collect participant information to create a STRIVE WorldWIDE account. Once the account is created, participants will be able to register and pay for individual courses (directions on how to do so will be sent separately).

The next course offering is Money Management which will begin September 9, 2019. The course is $299 and will run 5 weeks. Register before August 1, 2019 and used code EarlyBird for $50 off the course!

Email address *
What is the participant's first name? *
Your answer
What is the participant's last name? *
Your answer
What is the participant's email address? *
Your email address will be used to create your username for the course and communications for the course will be sent to the email address provided.
Your answer
What is the participant's home address? *
Please include city and state.
Your answer
What is the participant's phone number? *
Please include area code.
Your answer
What is the participant's date of birth? *
You must be 16 years old or older to participate in this program. There is no age limit.
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Optional: Contact information of person offering support
If you have someone who will be supporting you in this course and would like that person to receive course communication, please share that information here. You can always update this at a later date. Please provide the name of the person, relationship, email (if known), and phone number (if known). By providing this information, you are giving permission to share information about the course and your coursework with him/her.
Your answer
How do you plan to access this course? Choose all that apply. *
Much of the course can be accessed via your phone or tablet, but you will need access to a computer in order to access the seminars.
Required
Have you been diagnosed with an intellectual disability? *
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