Digital Skills Training Registration Form

Client self-registration for Digital Skills Training — submit and a Case Manager will review your application.

Please ensure all answers are correctly spelled and detailed to ensure accuracy.

Registration Details

First Name *

Last Name *

Date of Birth *

Phone *

If the guest has no valid phone number, enter (000) 000-0000.

Preferred Language

Region / Service Area *

City *

County *

Which Program(s) would you be interested in? (select all that apply)

Device Accessibility ProgramAdult Digital SkillsDigital Skills for FamiliesMedical AssistancePhlebotomyFiber Optics

Partner Referral / Location

Intake Assessment

Race*

Ethnicity*

Gender*

Are you a veteran?*

Is the head of the household female?*

Step 1: Digital ID

Do you have an email?*

Do you have a cell phone?*

Step 2: Digital Literacy

Do you have internet access, at home?*

What is the price range of your monthly internet?*

How would you describe your digital skill level?*

What devices do you have access to? * (select all that apply)

LaptopDesktopHotspotTabletSmartphoneOtherNone

Step 3: Transportation

This section helps to identify current/potential transportation barriers to ensure successful referrals (i.e., employment & education referrals)

What is your primary form of transportation?*

Step 4: Housing

What is your current place of residency?*

Please select any housing related assistance you require * (select all that apply)

Housing/Shelter/MotelElderly Home MaintenanceRent/Utility/Bill AssistanceNone

Current Housing Status*

Step 5: Work Ready

Please select any types of ID you possess * (select all that apply)

Social Security CardTX Drivers License/IDOut of State Drivers License/IDNone

In order to secure you employment, can you pass a drug test?*

Do you have a criminal background?*

Do you face any barriers to employment?*

Step 6: Financial Literacy

Do you have a bank account?*

Would you like to open a bank account?*

How many people live in your household?*

What is your annual household income?*

Step 7: Essentials

Please select from the following government programs you are currently enrolled in: * (select all that apply)

FoodFood Stamps (SNAP)MedicaidSection 8 / Federal Public Housing AssistanceSocial Security Disability Insurance (SSDI)Supplemental Security Income (SSI)Temporary Assistance for Needy Families (TANF)Type a Lifeline Assistance (Obamaphone / Assurance Wireless)Unemployment BenefitsWomen, Infants and Children Program (WIC)NoneOther

Please select any Essentials you need assistance with: * (select all that apply)

Personal CareChild CareFoodClothingOtherNone

Step 8: Healthcare

Do you use telehealth?*

Do you need assistance with any health-related concerns?*

Step 9: Education

What is your highest level of education?*

Are you interested in obtaining a degree/diploma, vocational training and/or certifications?*

Step 10: Employment

Are you currently employed?*

10-Step Checklist

The following steps have been identified based on your responses. Please review and adjust as needed.

Step 1: Digital IDStep 2: Digital LiteracyStep 3: TransportationStep 4: HousingStep 5: Work ReadyStep 6: Financial LiteracyStep 7: EssentialsStep 8: HealthcareStep 9: EducationStep 10: Employment

Participant Acknowledgement

I have reviewed and agree to the CBP Connect Terms, Privacy Notice, and Consent to Information Processing (Last Updated September 16, 2026).

I understand that information I submit may be collected, stored, used, and shared by The CARDBoard Project to evaluate eligibility, coordinate referrals, deliver services, track outcomes, and meet grant, audit, and legal requirements. The CARDBoard Project does not sell participant information.

I understand that information submitted through CBP Connect may be processed by artificial intelligence (AI) and automation tools to assist authorized staff, and that human review remains responsible for final decisions.

I consent to receive communications about program participation, applications, service coordination, and follow-up by email, telephone, SMS/text, postal mail, or electronic forms. I may opt out of non-essential text messages at any time.

I agree that electronic acknowledgements and signatures have the same legal effect as handwritten signatures, and I understand that submitting information does not guarantee eligibility, services, equipment, or enrollment.

I certify that the information I provide is accurate, complete, and truthful to the best of my knowledge. Where applicable, I represent that I am authorized to provide information and consent on behalf of the participant.

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Check all 6 acknowledgement boxes above to continue.