Registration Form

Complete the form below to register for Computers for Beginners.

First and Last Name

Address

Phone Number

Alternate Phone Number

Ethnicity

Are you currently enrolled in school? Yes
No

Current age?

Do you have a computer? Yes
No

How would you rate your computer skills? Beginner
Intermediate
Advanced

What is your highest level of education?

LITERACY FOR URBAN EMPOWERMENT CORPORATION