Organization Name
*
Main Contact Person
*
Individual who would be responsible for organizing the training and collecting feedback
First Name
Last Name
Main Contact Phone
*
(###)
###
####
Email
*
Signing authority name
*
Organizational signing authority, eg. Executive Director, etc.
First Name
Last Name
Organizational Mandate
*
Please add your organization's mandate
Social Media Handles
*
eg, @connectedcdns on Twitter, @connectedcanadians on Linkedin, Facebook and instagram
Our organization is a
*
Your organization can be registered federally or provincially.
Our population is made up of:
*
We are existing MOU/MOA partners of Connected Canadians
*
We have a Memorandum of Understanding or Memorandum of Agreement with Connected Canadians already in place.
How many seniors do you serve on a yearly basis?
*
Our Seniors
Our seniors (check all that apply):
*
My organization (please check all that apply):
*
Does your community have a reliable internet connection?
*
Training Interest
*
We have three levels of Cyber Safety training available.
What is the biggest need for seniors in your community?
*
To provide more context around the training, please let us know more about your community's needs.
Do your staff/ volunteer team members need training to support vulnerable others in the community, with respect to Cyber Safety?
*
Any other relevant details we should be aware of?
For example, if you selected 'Other' on any of your responses, please provide more details here.
