Digital Navigator Intake

Group Entries

"*" indicates required fields

Digital Navigators on behalf of groups of Clients in WA State

This form is used by Digital Navigators to capture information about group interactions with clients of theirs in Washington State. Entries will be incorporated into existing individual interaction reporting based on the time stamp of the submission date. The ability to import via .CSV is available upon request.
Digital Navigator
Zip Code*
Please enter only one Zip Code per entry
MM slash DD slash YYYY
Roughly how long (in minutes) was the event? 1.5 hours would be entered as 90 minutes, 2 hours would be 120 minutes, etc. This data will be used in aggregate with individual interaction data to provide visibility into how long it is taking to provide high quality high touch support to clients.
Helping categorize interactions allows for better understanding of the depth and breadth of the support given or needed to the clients in attendance. (Digital Platform includes things like Teams or Zoom)
Please select the PRIMARY reason for the group interaction. Additional information or detail can be captured in the text box at the end of the form.
Please select the need(s) supported for the interaction. Hold down the CTRL button and mouse click to select multiple options.
If applicable

Age Range

Gender Identity


Connectivity to the Internet

Demographic Data

Questions below enable analysis of how these demographic factors may be impacting digital access and/or understanding of how to use it.
Please use this section to capture follow up needs, specific challenges, or other relevant information to help tell the client story.
This field is for validation purposes and should be left unchanged.