Name Title
Organization Email
Street Address City
State Zip Code
Phone Fax
       
Please indicate to what extent you agree or disagree with each of the following statements. Please mark only one response for each statement. For any statements that do not relate to your experience, please respond with “N/A”. We’ve provided space for any additional comments that you’d like to share.
 
My agency is in need of a meeting space larger than what is available in my current facility.
 
My agency would utilize a training space with computer/internet connection if one were available to us.
   
In order to perform my job more effectively, I would be interested in a class in the following area(s):
(mark all that apply)
Staff Development Case Management Information Technology
Administrative Procedures Credit Counseling for Clients Basic Computer Skills
Basic Writing & Grammar Employment Counseling Computer Software Programs
Financial Management Legal Issues Website Development
Human Resources Working with the Disabled  
Professionalism in the Workplace    
Time Management    
Confidentiality & Ethics    
     
Other: Other: Other:
   
I employ the use of a computer to complete my daily tasks.
 
I am proficient in the use of a mouse.
 
I am proficient in navigating the internet.
 
I am proficient in basic computer maintenance.
 
I am proficient in using electronic mail.
 
I can send an email with an attachment.
 
I am proficient in web page development.
   
The operating system I use is:
(i.e.: Windows XP Pro, Windows XP Home, Windows ME, Windows 2000, Mac OS, Linux, Windows 98/95 , Windows 3.1, DOS)
   
I feel comfortable performing functions such as file maintenance (i.e. save, delete, organizing files) on my computer.
   
The word processing application I use is:
(i.e.: MS Word, MS Works, Lotus Notes/Word, Corel WordPerfect, Claris)
   
I am very proficient using ALL the tools available to me in my word processing application.
   
The spread-sheet application I use is:
(i.e.: MS Excel, MS Works, Lotus 1-2-3, Claris)
   
I am very proficient using ALL the tools available to me in my spreadsheet application.
   
The electronic mail application I use is:
(i.e.: MS Outlook, Outlook Express, Netscape Mail, Eudora, Hotmail, AOL, Yahoo!Mail)
   
I am very proficient using ALL the tools available to me in my electronic mail application.
   
List all of the types of database software you use in your job:
(i.e.: MS Access, SQL Server, FileMaker Pro, Raiser’s Edge, MicroEdge Gifts, Millennium, Donor Perfect, etc.)
   
I am very proficient using ALL the tools available to me in my database application.
   
The internet browser I use is:
(i.e.: Internet Explorer, Netscape, Mozilla)
   
I am very proficient using ALL the tools available to me in my internet browser.
   
Please indicate in what other areas a computer facility or large meeting space might benefit your agency: