Digital Navigator Intake

"*" indicates required fields

Digital Navigators on behalf of Clients in WA State

This form is used by Digital Navigators to capture information about individual interactions with clients of theirs in Washington State.
Digital Navigator
Zip Code*
Helping categorize interactions allows for better understanding of the depth and breadth of the support given or needed to the client.

Demographic Data

Questions below enable analysis of how these demographic factors may be impacting digital access and/or understanding of how to use it.
Is the client living in a Rural area?*
Is the client living with disabilities?
Does the client speak English as a second language and/or have a low English proficiency?*
Is the client deaf or hard of hearing?*
Is the client currently incarcerated, or has been incarcerated in the past?*
Is the client a veteran?*
Is the client an immigrant, refugee, or an asylum seeker?*
Is the client receiving Medicare or Medicaid?*
Does the client qualify for SNAP or Federal Public Housing Assistance?*
If so, they might also qualify for offers related to digital services.
Is the client at 150% or below of the US Federal Poverty Line?*
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.