Name

Phone Number

Are you interested in a BASIC/Entry Level Computer Course?

Yes

No

What Other courses might you be interested in?

Do you have a computer at home at the moment?

No

How do you propose to practice your skills

Yes

What type pf computer?

Desktop

Laptop

Tablet

Not sure

Do you have the Internet at home

Yes

No

Not Sure

If you use it can you give an example of what you use it for

Done Deal

RIP

Read the news

Social Media / Facebook

Other

Shopping?

Can you suggest areas you might like to learn about?

Yes

No

Not Sure

Take Note (Text box)

Do you have a working printer at home?

Yes

No

Phone

Date of Call

Do you use Social Media

No

Yes

Facebook

Social Media on the phone

Other

Email