| Your
Name |
|
| Your
E-mail |
|
| Full
Name of the Unit |
|
| Where
is the unit located? |
|
Do you provide services in places other than your main location?
|
No Yes |
| Contact
Names |
|
| Contact
Phone Numbers |
|
Who are the primary users of the access facility (e.g., seniors,
school children)?
|
|
Who is eligible to use the available technology (e.g., anyone,
members of an organization)?
|
|
What access-related services do you provide? (check all that
apply)
|
General-use
computing (word processing, spreadsheets, etc.)
Internet
access
E-mail
Fax |
| When
did the program start? |
|
What, if any, fees are charged? (specify)
|
|
Specify the number of equipment units available for the following
public access services.
|
General-use
computing Fax
Internet
Access
Telephone |
| Hours
the unit is open for public use: |
| Day(s) |
From |
To |
|
|
|
|
|
| Are
helping personnel available? |
No Yes
(number
of people) |
| Are
training courses offered? |
|
| Are
there any filters on usage (e.g., certain Internet sites blocked,
no long-distance calls)? |
No
Yes |
What groups or organizations are currently providing support
equipment to your unit?
|
|
| Is
there anything else that is important to convey in describing
your unit's services? |
|