Digital Equity Program Interest Form

Digital Equity Program

Interest Form
Would you like some help to boost your technology and computer skills? This program can help you improve your digital and computer literacy skills. Learn how to use the internet, understand and use email, focus on computer safety, and get an introduction to Microsoft Word and Excel. The New Jersey Department of Labor funds this program.”
Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Last 4 digits of Social Security #
E-mail:
Phone Number:
Format: (000) 000-0000.
This phone number is...
I live in...
WFNJ Participant
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