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Bridging the Digital Divide:
Digital Access & Literacy Program

Complete the form to apply!

Check all preferred services below that you like to apply for:


General Information:

Please enter your first name.
Please enter your last name.
Please enter your email address.
Please enter your phone number.

Home Address:

Please enter your home address.
Please enter your city.
Please enter your state.
Please enter your zip code.

Date of Birth:

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Gender:

Ethnicity:

Disability / Diagnosis:

Benefits / Services Received:

Caregiver / Service Provider:

Annual Income Information:

Marin County Residency:

Home Type:

Occupancy:

Digital Access:

Do you have access to a device (made within the last 2 years) that can go online?
Do you currently have access to high-speed internet?

If you are applying for the digital literacy program, what do you hope to learn from this training?
If you are applying for a Chromebook, what will be the primary use for this device?

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