CSC Form

The following form seeks your input on the direction which the Computer Science Committee will take during the next year as far as training. We will first obtain a little personal information. Then, we will offer you a survey to fill out to determine what you wish to see as far as training.

First Name	Middle Initial	Last Name
Address
Address2
City	State	Zip
Home Phone	Work Phone
	E-Mail:

The Computer Science Committee wwants to determine what you wish to learn in the area of adaptive equipment. Please either check the items which interest you or fill in the blanks as requested below.

How would you rank your computer skills:

Have you ever taken computer/Assistive Technology classes through the Federation Center of the Blind?

If you have, Please list them and the date below.

Course	Date
Course	Date
Course	Date

Which of the following classes would you take if offered? Check all that apply:

JAWS Basics	Microsoft Outlook With JAWS
Outlook Express with JAWS	Internet with JAWS
Basic Word Processing with Microsoft Word and JAWS	Advanced Word Processing with JAWS
Microsoft Excel Basics with JAWS	Microsoft Powerpoint with JAWS
Zoomtext Basics	Microsoft Outlook with ZoomText
Outlook Express with Zoomtext	The Internet with ZoomText
Basic Word Processing with Microsoft Word and ZoomText	Advanced Word Processing with Microsoft Word and ZoomText
Microsoft Excel with Zoomtext	Microsoft Powerpoint with ZoomText
OpenBook Basics	Introduction to the PacMate
Using the PacMate Calendar	Using the PacMate addressbook
Using e-Mail on the PacMate	Pocket Excel on the PacMate
Basic Word Processing on the PacMate	Using PacMate Desktop
	Kurzweil-NFB Reader Basics

If any other, please specify.
Extra 1:
Extra 2:

Would you be interested in teaching a class?

Please specify: