Data Form for Info to Support DEA Funding
Local Program Contact Information
Local Program Name
Your role at your local program:
Administrator
Coordinator
Counselor
Teacher
Other
First Name
Last Name
Address
City
State
Please select...
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
AB
BC
MB
NB
NL
NT
NS
NU
ON
PE
QC
SK
YT
Zip Code
Phone Number
Email
Program Details
Program Type?
Community Based Organization
Community College
Library
Multi-Service
Prison
School District
Workplace
Other
If you selected Other above, please indicate here:
What types of services does your program provide? (check all that apply)
ABE
Citizenship
Digital Literacy
ESL
GED
IET
Workforce Readiness
Other
If you selected Other above, please indicate here:
How many adult learners are served annually by your program?
Is your program federally funded?
Yes
No
Unsure
Has your program received any CARES Act or American Rescue plan funding?
Yes
No
Unsure
Is your program primarily urban, suburban, or rural?
Urban
Suburban
Rural
Does your program serve as a hub for Wi-Fi and device dissemination?
Yes
No
Unsure
- If so, how is this initiative funded?
- If not,
does your program have the Wi-Fi and devices needed to run the classroom well?
Yes
No
- If not, how many devices and hotspots are needed?
Do your adult learners have Wi-Fi and devices?
Yes
No
Unsure
- If not, quantify needs below:
Families
Individuals
Children
Do your adult learners have Wi-Fi and devices at home?
Yes
No
Unsure
Are your adult learners sharing Wi-Fi and devices at home?
Yes
No
Unsure
-
If so, how many family members share Wi-Fi?
-
If so, h
ow many share devices?
- Does this hinder your adult learners from attending class or completing assignments?
Yes
No
-
If so, how many that you are aware of?
Do you offer digital literacy classes to adult learners?
Yes
No
Unsure
How many in your program could benefit from digital literacy services?
Are you attending the Digital Equity Session that COABE is offering in partnership with the Department of Education (
details here
)?
Yes
No
Unsure
Did your local program take advantage of any of the following initiative?
Google Applied Digital Skills
Google Scholars
IBM SkillsBuild
None of the Above
Feedback/testimonials/comments
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Contact Information