Registration | The Senior Lift

Name *

First

Middle

Last

Date of Birth

Address, City, State & Zip *

Home Phone *

Cell Phone *

Level of Education *

Email *

What type of industry do you or did you work in (if retired)? *

On a scale of 1 to 10; how comfortable are you with technology?

Selected Value: 0

What type of industry or career are you interested in training for? *

Which of our courses would you be interested in? (Select as many as you'd like!) *

Smartphone Basics
Computer Basics
Internet Basics

** There is no charge for registration for classes. Registration & Assessment Form must be completed before registering. If you have questions, please call us at 610-639-6737. **

What technology devices do you own or use most frequently? *

PC
Laptop
Smartphone
Tablet

Choose all that apply.

What types of things do you do on your devices? *

Choose all that apply.

Do you own a smartphone? (pick one)

Yes
No

If you have a Smartphone, please answer the following questions. If you do not own a Smartphone, skip to question # .

What apps do you use on your Smartphone?

ex: Camera, Facebook, Calendar, etc.

How often do you use a Smartphone? *

Everyday
Few times a week
Rarely
Never

Do you have voicemail set up on your Smartphone?

Yes
No

Do you have a contact list set up on your Smartphone?

Yes
No

Can you take photos/manage photos on your Smartphone?

Yes
No

Do you use GPS on your Smartphone?

Yes
No

Who is your current cell phone provider and plan?

ex: Verizon, AT&T, T-Mobile, US Cellular, etc.

Do you understand your cell phone plan?

Yes
No

Do you use video conferencing?

Yes
No

ex: Skype, FaceTime, Facebook Live, ect.

Do you know how to get to your settings on your Smartphone?

Yes
No

What are three things you'd like to learn how to do on your Smartphone?

Do you own a PC or Laptop? (pick one)

Yes
No

How often do you use a PC, or Laptop? *

Everyday
Few times a week
Rarely
Never

What are three things you'd like to learn how to do on your PC?

Are you comfortable with technology terms & symbols?

Yes
No

Do you have any mobility problems that interfere with your use of computers?

Yes
No

Have you ever done technology training before?

Yes
No

Registration Form & Assessment Form