"*" 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
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 predominant reason for the interaction. Additional information or detail can be captured in the text box at the end of the form.
If applicable

Age Range

Gender Identity

Race

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.