Digital Navigator Forms

Framework provided by National Digital Inclusion Alliance

Use the following forms to support working with clients and collecting data.

Your organization may already have a version of these documents-- feel free to use those instead.

These forms cover:

Intake
Skills assessment
Session Summary
Follow Up

PLA does not need copies of these forms. Please keep them for your records.

Once all meetings and follow-ups with a patron/client are complete, please complete a brief Survey.

The Survey collects just the essential data. You can preview the survey questions HERE

Forms in English

Intake Form: Use this form to collect general information about your community member’s technology needs.

(.pdf, 342.12 KB)

Skills Assessment: The purpose of this form is to get a general idea of your community member’s comfort with technology.

(.pdf, 332.23 KB)

Session Summary Form (formerly “Exit Survey”) To be completed after speaking with a community member to record details of the interaction.

(.pdf, 327.42 KB)

Follow-up Survey To be completed with a community member at regular intervals as a matter of checking in, and also to record any growth in their learning.

(.pdf, 324.14 KB)

Forms in Spanish

Intake Form SPANISH

(.pdf, 353.38 KB)

Skills Assessment SPANISH

(.pdf, 347.75 KB)

Session Summary Form (formerly “Exit Survey”) SPANISH

(.pdf, 314.31 KB)

Follow Up Form in Spanish: Coming Soon

Need more resources?

NDIA's Digital Navigator Resources