Senior Planet Participant Interest

Contact Information

Please fill out the following form help us shape the type of programming we bring to you!

First Name

Last Name

Email

Do you wish to be contacted about future Senior Planet events?

Yes

No

Questions

1. On a scale of 1-5, how interested are you in technology classes?

Not interested

Very interested

2. Please select the programs you are interested in:

Financial Security

online banking, online shopping and job searching

Health and Wellness

online health resources, telemedicine and MyChart

Creative Expression

Google Photos, YouTube and Smartphone photography

Civic Engagement and Advocacy

How to spot fake news, crowdfunding for a cause and online tools for contacting your lawmakers

3. How comfortable are you using technological devices, such as Smartphone, tablet, and/or computer?

Not comfortable

Very comfortable

4. Please indicate the best days and times that meet your schedule:

Questions	Morning	Afternoon	Evening
Monday	Morning	Afternoon	Evening
Tuesday	Morning	Afternoon	Evening
Wednesday	Morning	Afternoon	Evening
Thursday	Morning	Afternoon	Evening
Friday	Morning	Afternoon	Evening
Saturday	Morning	Afternoon	Evening
Sunday	Morning	Afternoon	Evening

Please check all that apply

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.