Technology Program for Older Adults

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Interest Form

Thank you for your interest in our Technology Program for Older Adults. We are looking forward to helping you feel more comfortable using your phone, tablet and computer.

Please fill out your information below and someone will be in touch with you.

Contact Information

Name*

Address*

County*

Phone Number*

Phone Type*

Email*

Date of Birth*

Synagogue Affiliation*

Registration Questions

Tell us what technology you have*

iPhone
Android Phone
iPad
Tablet (Samsung, Microsoft, etc)
Apple (Mac) Computer
PC Computer
I don't know
Other

Tell us what you need help with*

Something's not working
I want to learn Zoom
I want to learn how to FaceTime
I want to learn how to use my phone or tablet better
I want to learn how to play games online
I want to learn how to use Amazon for shopping
I want to learn how to access my doctor
I want to learn how to watch movies online
Other

Do you have any accessibility constraints? Please check all that apply

Vision Impairment
Hearing Impairment
Dexterity Impairment
Other

Is there anything else you would like to tell us?

Scheduling

Please let us know your preferences for class day and time (you can select more than one):

Dates*

Monday
Tuesday
Wednesday
Thursday
Friday
9am-10:30am
10:30am- 12pm
12pm-1:30pm
1:30pm-3pm
3pm-4:30pm

By submitting this form, you agree to receive recurring automated marketing messages at the phone number and email provided. Consent is not a condition of purchase and/or registration. To unsubscribe from text messages, reply STOP at any time. To unsubscribe to marketing emails, click “update your preferences” or “unsubscribe from this list” at the bottom of the email received.

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