Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *How Frequently Do You Check Your Email?Several Times a DayOnce a DayA Couple of Times a WeekCan't RememberI Don't Have an Email AddressHow Frequently Do You Check Social Media?Several Times a DayOnce a DayA Couple of Times a WeekCan't RememberI Don't Have an AccountPlease answer the following (1 being not confident at all, 5 being Very Confident) I Feel Confident Using the Internet?12345I feel confident I can Find Out About Events in my Community?12345I feel confident I can Use the Internet to Connect With Friends and Family?12345I feel confident I can Use the Internet for Entertainment?12345I feel confident I can Use the Internet to Search for Job Opportunities?12345I feel confident I can Use the Internet to Schedule Telehealth Appointments?12345I feel confident I can Use the Internet to Check my Bank Account?12345Do You Use the Internet for Anything Else?Submit
