Clayton County - Adult Digital Literacy Workshop - May 29, 2024 -- REGISTRATION

Thank you for your interest in our upcoming workshop!

We ask that the registration form be completed by the adult who is planning to attend the workshop.

You will know that your registration has been completed successfully and you have a spot reserved in the workshop when you click "done" after the last question and see the message that begins with "SUCCESS! Your registration is complete and you have reserved your spot in our workshop on May 29.

Please plan to take a screen shot of that message so you have the confirmation for your records.

The team at Inspiredu looks forward to working with you!

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* 1. Name of Adult who will attend the workshop

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* 2. Email Address

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* 3. Phone Number (cell preferred)

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* 4. YEAR of birth

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* 5. Current age range

Under 20

20-29

30-39

40-49

50-59

60-69

70 or older

I prefer not to answer

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* 6. Gender

Female

Male

Non-Binary

Other

I prefer not to answer

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* 7. Ethnicity/Race

American Indian or Alaskan Native

Asian

Black or African American

Hispanic or Latinx

Native Hawaiian or Other Pacific Islander

White

Multi-Racial

I prefer not to answer

Other (please specify)

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* 8. Language Spoken Most Often at Home

English

Spanish

I prefer not to answer

Other (please specify)

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* 9. Complete Address of Your Residence

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* 10. What county do you live in (Example: Cobb, DeKalb, Fulton, Jasper, etc)

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* 11. Highest Level of Formal Education of Parent/Guardian

Completed some High School

Earned a High School Diploma, GED, or Equivalent

Completed a Technical School Certification or Career/Job Training Program

Completed some College

Earned a College Degree

I prefer not to answer

Other (please specify)

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* 12. Are you or any other adult in your Household currently enrolled in a formal program to further your own education? (example: GED, certification program, college classes, job training, etc)

Yes

If you answered "yes" - please indicate what type of program

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* 13. Annual Household Income (combined total for your household)

$10,000 or less per year

$10,001 - $20,000 per year

$20,001 - $25,000 per year

$25,001- $35,000 per year

$35,001 - $50,000 per year

$50,001 - $75,000 per year

More than $75,000 per year

I prefer not to answer

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* 14. How many Adults are in your household?

More than 5

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* 15. Are you the parent/guardian/caregiver of any children age 0-17?

Yes

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* 16. How many children (ages 0-17) live in your household?

More than 5

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* 17. How many computers (desktop, laptop, or tablet) are currently in your home? Please include both those you own and those that may be on loan to you from a school and/or organization.

None

More than 3

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* 18. Of the computers in your home, how many do you/your family own?

There is not a computer in my home.

I/my family DO NOT OWN any of the computers in my home.

I/my family OWN SOME OR ALL of the computers in my home.

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* 19. What type of Internet access do you currently have in your home?

NO Internet access at my home

Internet access only from a cell phone

Internet access through broadband, fiber, or cable provider (examples: Comcast, Xfinity, AT&T, etc) or other/ unsure of the type

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* 20. Our workshops include refreshments for learners. Do you/your child have any dietary preferences?

No preference

Vegetarian

Kosher

Gluten Free

Other (please specify)

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* 21. Our goal is for all learners to be comfortable when attending our workshops. Do you have any needs that we may be able to accommodate? (Example – mobility, vision, hearing, etc)