PROJECT LITERACY COMMUNITY TECHNOLOGY CENTER

Please print out registration form and fill it out. Then mail form to Project Literacy.

Name of Course:________________ Course Start Date:_____________
Instructor:_____________________ Student's Computer Operating System: 95   98   ME   XP


Name:_________________________Home Phone:_________________
Address:_______________________City:__________State:____Zip______

Work or Msg. Phone (if different):____________E-mail________________
Would you like to receive up-coming class schedules via e-mail?_____

Do you have any physical conditions that may require special assistance?


Computer Skills Assessment Questionaire

Equipment: (Circle as many of the item numbers below as apply to you)

     1.   I am technologically terrified.
     2.   I have never used a computer.
     3.   I do not own a computer.
     4.   I own a computer but am uncomfortable using it.
     5.   I have used a computer for a while but would like to learn how to do more with it.
     6.   I am an experienced computer user but would like to develop my skills further.

Previous Courses Taken: (Please check mark next to the applicable items)

Project Literacy Basic Computing I ____    Project Literacy Computing Skills II ____
Project Literacy Internet & E-mail _____    Project Literacy Word or Excel       ____
UCC Extension Basic Computing  _____    Any other Computing Courses (specify)____
On-line computer training courses  _____    _____________________________________

Personal Objectives:
Please state below what you hope to achieve at the completion of this class.
_________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________