EmailMe Form - WIN Digital Literacy Survey

CID

Date Time *

MM / DD / YYYY

Date of Birth

MM / DD / YYYY

Name *

First Last

Email *

Home Phone *

### - ### - ####

enter your cell phone if you do not have a home phone line.

Mobile Phone *

### - ### - ####

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

County *

In which county do you live?

Are you eligible for or participating in Medicaid? *

Are you 18 years of age or older? *

Have a mental health diagnosis or IDD? *

If yes, please identify *

Substance Use Disorder/Recovery? *

Opioids? *

If yes to substance use/opioids, please identify *

Have employment barriers because of: *

Services Needed *

Veteran? *

Discharge Status *

Marital Status *

Do you need bus passes to attend classes? *

Hispanic or Latino *

Race *

Pronouns *

Gender Identity *

Birth Sex *

Transgender? *

PART 2:

Digital Literacy Questions

What are your goals for digital literacy classes? *

Do you need any Assistive Technologies, please describe: *

Tools for Accessibility (e.g., screen readers, voice recognition) Customizing Devices for Accessibility, Accessible Web Browsing

Do you have a Keystone ID? *

Do you have a SkillsUp Login? *

Yes or No *

	Yes	No
Do you have a resume?
Do You have employment references?
Do You have a Cover Letter?
Do You have Thank You Letters?
Do You have a professional email account?
Do you have Log-ins created on Job Boards? i.e. LinkedIn, Indeed, Glassdoor, Monster, CareerBuilder, ZipRecruiter, SimpyHired, Dice, Snagajob, and Government Job Boards
Do you know how to use the Job Boards effectively? i.e. search filters, set up job alerts, setting up resumes based on position

Employment Information *

Are you employed?
PT or FT
How much do you make per hour:
How many hours per week do you work:

Income Information: *

Are you currently on SSI or SSDI?
How much per month:
Other income?

General Skills Analysis Evaluation: *

Reading Level: None, Grade School, Middle School, High School, College
Typing Speed, WPM

On a scale of 1-10 (1 - lowest & 10 - highest) How familiar are you with the following: *

	1-10
Basic Computer Skills
Introduction to Computers
Operating Systems (Windows, macOS, Linux)
File Management and Organization
Basic Troubleshooting
Internet Skills
Introduction to the Internet and Browsers
Search Engine Usage
Email Basics
Online Safety and Security
Understanding and Avoiding Online Scams
Productivity Software
Word Processing (e.g., Microsoft Word, Google Docs)
Spreadsheets (e.g., Microsoft Excel, Google Sheets)
Presentation Software (e.g., Microsoft PowerPoint, Google Slides)
Calendar and Scheduling Tools
Communication Tools
Email Etiquette
Video Conferencing (e.g., Zoom, Microsoft Teams, Google Meet)
Instant Messaging and Chat Tools (e.g., Slack, WhatsApp)
Social Media Literacy
Overview of Popular Social Media Platforms (Facebook, Twitter, Instagram, LinkedIn)
Creating and Managing Social Media Accounts
Privacy Settings and Digital Footprint
Responsible Social Media Use
Digital Content Creation
Basic Graphic Design (e.g., Canva, Adobe Spark)
Video Editing (e.g., iMovie, Adobe Premiere)
Blogging and Content Management Systems (e.g., WordPress)
Introduction to Coding (e.g., HTML, CSS, JavaScript)
Online Collaboration Tools
Cloud Storage and File Sharing (e.g., Google Drive, Dropbox)
Collaborative Document Editing (e.g., Google Docs, Microsoft Office 365)
Project Management Tools (e.g., Trello, Asana)
Digital Research Skills
Evaluating Online Sources
Using Online Libraries and Databases
Academic Integrity and Plagiarism
Citing Online Resources
E-commerce and Online Transactions
Online Shopping and Payment Methods
Understanding E-commerce Platforms (e.g., Amazon, eBay)
Online Banking and Financial Security
Digital Privacy and Security
Understanding Digital Footprints
Setting Up and Managing Passwords
Identifying and Avoiding Phishing and Malware
Using VPNs and Encryption
Emerging Technologies
Introduction to Artificial Intelligence
Understanding the Internet of Things (IoT)
Basics of Blockchain and Cryptocurrencies
Virtual and Augmented Reality

On a scale of 1-10 (1 - lowest & 10 - highest) How familiar are you with the following: *

	scale of 1-10
Familiarity with Mobile Devices
Email Apps, Notifications
Mobile Browsers
Bookmarking
Playstore/Downloading Apps/Notifications
Document Management/Editing
PDF Readers
Calendar and Scheduling Tools
Syncing
Phone Calls/Text messaging
Voicemail Setup
Video Conferencing (e.g., Zoom, Microsoft Teams, Google Meet)
Camera & Microphone
Security & Privacy
Two-Factor Authentication
Digital Business Cards

Date Time

MM / DD / YYYY

PART 2: Digital Literacy Questions

PART 2:

Digital Literacy Questions