Your Goals

Why are you interested in joining the Digital Skills Academy at this time? *

Which area are you most interested in receiving support in? *

Building basic computer skills and confidenceFoundational Digital Literacy track Preparing for a job or career transitionCareer Pathway track Not sure yet — still exploring

How ready do you feel to take the next step in your career? *

1 = Not ready at all · 5 = Fully ready

How clear are you about your next career step? *

1 = Not very clear · 5 = Very clear

Which direction best describes where you are headed? *

A new job or job change Better role or pay in my current field Training or certification Entrepreneurship or freelance Not sure yet

Contact Information

First Name *

Last Name *

Email Address *

Phone Number *

Tech Confidence

Rate your current confidence from 1 (not confident) to 5 (very confident).

Which class format are you applying for? *

Virtual In-person Either option works for me

Do you have reliable internet access to participate virtually? *

Yes No Sometimes

Do you have access to a computer or laptop for class? *

Yes No — I may need a device

About You

Date of Birth *

Age Group *

Gender *

City *

State *

Zip Code *

Race / Ethnicity *

Select all that apply.

American Indian / Alaskan Native Black / African descent Hispanic / Latino / Latinx Asian White / European descent Middle Eastern / North African Multiracial Prefer not to say

Do you reside in a Westside community zip code? *

Yes — I reside in 30310, 30311, 30312, 30314, or 30318 No — I reside outside these areas

Employment and Income

Are you currently employed? *

Yes, full-time, salaried Yes, full-time, hourly Yes, part-time Self-employed Unemployed and looking Unemployed and not currently looking

Industry or type of work

Hours per week

Number of people in household *

Number of children and ages *

Household income *

$0 – $14,580 $14,580 – $19,720 $19,720 – $24,860 $24,860 – $30,000 $30,000 – $35,140 $35,140 – $40,280 $40,280 and above

Check all that apply

Single parent / guardian Dislocated worker Displaced homemaker Divorced / separated Houseless

Current salary or hourly pay *

Respond N/A if unemployed.

Background

Highest level of education *

Current housing situation *

Own home or apartment Rent home or apartment Share housing with others Living with friends or family Homeless shelter Transitional housing

Do you receive SNAP, Medicaid, SSI, FPHA, or VA Benefits? *

Yes No

Are you a U.S. military veteran or currently serving? *

Veteran Currently serving No Prefer not to say

Are you a returning DSA student? *

Yes No

How did you hear about our program? *

Name of DSA alum or student who referred you

Interested in advanced training after this program? *

Yes, business essentials Yes, other Unsure Not at this time

Is there anything about your goals or circumstances you would like us to consider?

Before You Submit

The Digital Skills Academy is an 8-week training program that requires active participation and consistent attendance. I acknowledge and agree to these expectations.

I confirm that the information provided in this application is accurate to the best of my knowledge.

APPLICATION

Application Received.