V360 TECH Community Interest Form

Thank you — your interest form has been received.

A member of the V360 TECH team will follow up with you soon.

If you would like to reach us sooner, please call 704-921-1527.

We could not submit your form

Website (leave this field empty)

Contact Information

Full Name (required)

Phone Number (required)

Email Address (required)

What is your date of birth? (optional) For example: 4 27 1990. You may leave this blank.

Month

Day

Year

Preferred Method of Contact (required)

Phone call Text Email

Best Time to Contact You (select all that apply)

Morning Afternoon Evening

Program Interest

Are you completing this form for yourself or someone else? (required)

Myself A family member A client/customer Someone I support professionally

Are you blind or do you have low vision? (optional)

Yes No I am not sure I am completing this for someone else

What kind of support are you interested in? (select all that apply)

Learning to use a smartphone Screen reader training Computer skills Email or internet use Assistive technology devices Help accessing online services Employment-related technology skills General digital confidence Other

Are you currently receiving technology training somewhere else? (optional)

Yes No Not sure

Did you ever serve in the military? (optional)

Yes No Prefer not to answer

Are you currently working with DSB or another organization? (optional)

Yes No Prefer not to answer

Are you a student? (optional)

Yes No Prefer not to answer

Access and Support

Do you currently have access to a smartphone, tablet, or computer? (select all that apply)

Smartphone Tablet Computer I do not currently have access to a device

Do you need transportation assistance to attend in-person training? (optional)

Yes No Maybe

Preferred Training Format (optional)

In person Virtual Either

What is your primary goal for participating in V 360 TECH? (optional)

Is there anything else you would like us to know? (optional)

V360 TECH Community Interest Form

There is a problem

Thank you — your interest form has been received.

We could not submit your form

Contact Information

Program Interest

Access and Support

Consent

V360 TECH Community Interest Form

There is a problem

Thank you — your interest form has been received.

We could not submit your form

Contact Information

Program Interest

Access and Support

Consent

Cookie Settings