* First name

* Last name

* Date of birth (DD/MM/YYYY)

* Address

Postcode

If possible please let us have a telephone number where you can be contacted

Telephone number

* Form completed at
Boothstown library Broadwalk library Broughton library Cadishead library Charlestown library Clifton library Eccles library Height library Hope library Irlam library Little Hulton library Ordsall library Swinton library Walkden library Winton library Worsley village library Other

*Any previous computer experience?
None at all
A little
Completed basic course

Other (please state)

Are you okay using a mouse?
Yes   No

*Why would you like computer training?
General interest
Email family abroad
Keep up with things
Help children with homework

Other (please state)

Training required and level
Absolute beginner (15 or 20 week introduction course)
Email (must have some prior computer skills for this)
Internet (must have some prior computer skills for this)
Progression (follow on from beginners course)

Other (please state)

Times when NOT available for training (lots of unavailability may increase the waiting time before being offered a course)

Please tick times when you are NOT available

Please select up to 3 locations for training

* 1st choice
Boothstown library Broadwalk library Broughton library Cadishead library Charlestown library Clifton library Eccles library Height library Hope library Irlam library Little Hulton library Ordsall library Swinton library Walkden library Winton library Worsley village library Langworthy cornerstone The Angel Healthy Living Centre Meadows resource centre

2nd choice
Boothstown library Broadwalk library Broughton library Cadishead library Charlestown library Clifton library Eccles library Height library Hope library Irlam library Little Hulton library Ordsall library Swinton library Walkden library Winton library Worsley village library Langworthy cornerstone The Angel Healthy Living Centre Meadows resource centre

3rd choice
Boothstown library Broadwalk library Broughton library Cadishead library Charlestown library Clifton library Eccles library Height library Hope library Irlam library Little Hulton library Ordsall library Swinton library Walkden library Winton library Worsley village library Langworthy cornerstone The Angel Healthy Living Centre Meadows resource centre

* Do you have any disability, which would affect you when using a computer?
Yes
No

• We have a specially adapted (large size) keyboard & mouse
• We can increase the size of content on screen for easy reading
• We can change colours and fonts for easy reading

Do you have any special needs (e.g. wheelchair access, eyesight problems, restricted hand movements)