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This form is for the Anglicare Retirement Village Castle Hill Computer Club to enter session details for each participant.

Learner Session Details for Anglicare Techmates

You are completing this form on behalf of your learner. Please enter their details.

"*" indicates required fields

Is this Student an Existing Learner or a New learner?*

Please let us know if this learner has registered with us or is a brand new first time learner.

New Learner Registration

The New Learner Registration Form only needs to be completed once for each Learner. We need this form to create a DEX profile to be able to log sessions. Thank You!

Existing Learner Session Entry

This form is for Tech Mates entering the session details for their Learners

Learners Name*

First Last

Learner Contact Number*

Gender*

Email

Is the Learner Continuing?

Please let us know if the Learner intends to cease being mentored so we can remove them from our listing.

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Address*

Street Address Address Line 2 Suburb State Postcode Country

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Language Spoken

Date of Birth*

DD slash MM slash YYYY

Is Date of Birth Real?*

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Indigenous Status*

Country of Birth*

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Disability Type

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Disability or Condition*

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Existance of Carer*

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Why Come?

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Accomodation*

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Living Arrangements*

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DVA Card Status*

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How Did You Find Us?

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How Often Device Used?

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Digital Skills Rating?

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Confidence Level

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Be Connected

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Preferred Delivery

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Learner Status

Active

Not Active (Withdrawn)

Withdrawn (Do Not Contact)

On Hold

New Learner Form Completed

Awaiting Tech Mate

Unable to Contact

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iPad Program

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Agree To Be Contacted?

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Session Type*

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CHSPArea

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Venue*

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MyAgedCare Access?

Would the Learner like assistance with accessing the benefits in the MyAgedCare system?

Consent*

I agree to the privacy policy and have Learner consent in the Data Exchange.

I agree to and have consent to collect the Learners personal information and store it on the Data Exchange and also to participate in any follow up research, along with these conditions in the Australian Government Data Exchange here.

Session Details

Session Date*

DD slash MM slash YYYY

Tech Mate Name*

Main Device Used*

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Tech Mate Email

Other Techmate Name

First Last

Please fill in your name here if it is not listed in the dropdown box.

Length of Session*

30 minutes - 0.50

1 hour - 1.00

1.5 hours - 1.50

2 hours - 2.00

2.5 hours - 2.50

3 hours - 3.00

Mentor Notes

Complete if you wold like to keep a record of progress.

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Supported by the Australian Government Department of Health and Aged Care

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In the spirit of reconciliation, the Digital Literacy Foundation acknowledges the traditional custodians of the land, waters and knowledge for the places where we gather to collaborate and strengthen communities. In our work, we recognise the importance of Country - not just as a place, but how it also maintains community, family, kin, lore, and language. We pay our respects to Elders past and present. This always was, always will be, Aboriginal land. We support the Uluru Statement from the Heart and support a First Nations Voice to Parliament being enshrined in the Australian Constitution. Aboriginal and Torres Strait Islander peoples are advised that this website may contain images or names of people who have passed away.