Customer Interaction Form – Finger Lakes
Today's Date
(Required)
MM slash DD slash YYYY
Estimated Time Spent (in minutes)
(Required)
Do you have a Library Card?
(Required)
Yes
No
Will Acquire
Location
(Required)
Select your library
Dundee Library
Geneva Public Library
Macedon Public Library
Naples Public Library
Ontario Public Library
Palmyra Community Library
Wood Public Library
Victor-Farmington Public Library
How did patron hear about our Digital Literacy Program?
(Required)
Community Flyer/Sign
Computer Help Sign
Friend/Family
Librarian
Referral From Agency/Organization
Repeat Customer
Volunteer Initiated
No Response
Name of Agency/Organization
Computer helper?
Select your volunteer
Nancy F.
Annie H.
Sarah C.
Cass K.
Catherine R.
Ellen C.
Dan F.
Craig Z.
Nick C.
Lam B.
Maria N.
Jeremy V.S.
Person completing this form
(Required)
Digital Literacy Volunteer
Customer/Patron/Student
Section 1: Customer Information
This information is to track the effectiveness of our work in the community and to demonstrate the need for our services. The personal information below is not viewable by outside individuals or agencies. We need DATE OF BIRTH and ZIP CODE for these forms to help support the funding and continuation of the program. If you do not wish to share, please place an X in those fields so that the volunteer may still record their work with you today.
Name (NOT REQUIRED)
First
Last
ZIP Code
(Required)
Year born?
(Required)
Hidden
Date of Birth
MM slash DD slash YYYY
No longer in use
Gender
(Required)
Female
Male
Other/Non-binary
Prefer not to say
Race
(Required)
African American
African Native
Afro-Caribbean
Alaska Native/Pacific Islander
Asian
Caucasian
Native American
Ethnicity
(Required)
Hispanic/Latino
Non-Hispanic
Highest Education Level
(Required)
Elementary School
Some High School, diploma not received
High School/GED/TASC
Some college, degree not received
2-year college
4-year college
Advanced Degree (PhD, MBA, MS, etc.)
Did not respond
Employment status
(Required)
Retired
Employed
Employed, seeking additional work
Unemployed, seeking work
Unemployed, Not seeking work
Unable to work, Disability or Illness
Did Not Respond
I am a(n)... (NOT REQUIRED)
Immigrant (regardless of citizenship)
Refugee (regardless of citizenship)
US Military Veteran
Active Reserve/Guard
Adult Student
Parent
Section 2: What Was Accomplished Today
Did you use NorthStar Online Learning?
(Required)
Yes
No
New or returning NorthStar student?
Select your response.
Current Student
New Student
Returning Learner
What did you practice in NorthStar?
Basic Computer Skills
Internet Basics
Email
Windows
MacOS
Microsoft Word
Microsoft Excel
Microsoft PowerPoint
Google Docs
Social Media
Information Literacy
Career Search Skills
Your Digital Footprint
Telehealth
What tasks did you complete today?
(Required)
Social Services
Computer Literacy
Applied for Services
Workforce Readiness
Applied for a job
Citizenship
Financial Literacy
Legal
Health Literacy
Social Services
Complete benefit form(s)
Access online resources (ex. mybenefits.ny.gov)
Communicate with governmental agencies
Other (please describe in unlisted skills section)
Social Services: Other
Please explain further.
Computer Literacy
Create an email account
Create or navigate a social media account
Create, edit, or save a digital document
Learn new smartphone skill
Complete an online search and/or navigate a website*
Learn Microsoft/Google Suite Skills
Recover an online account (e.g., reset password)*
Upload a document to email or Drive
Utilize Print/Fax/Scan services
Accessing library catalog
Other (please explain below)
If "Other" is selected, please explain in "Other computer skill or task" section below.
Applied for Services
Subsidized housing
Child Health Plus
Healthy New York Insurance
SNAP (Food Stamps) Benefits
HEAP (Home Energy Assistance Program)
Unemployment Benefits
Other (please explain below)
If "Other" is selected, please explain in "Other computer skill or task" section below.
Hidden
Workforce Readiness
Create or update a resume
Create employment correspondence
Read and understand work-related documents
Read and understand training materials
Obtain information about college or training or jobs
Apply online for education or training
Create Job site Account*
Complete Job Skills Assessment*
Workforce Readiness
Create or update a resume
Create employment correspondence
Read and understand work-related documents
Read and understand training materials
Obtain information about college or training or jobs
Apply online for education or training
Create Job site Account*
Complete Job Skills Assessment*
Number of job applications submitted
Hidden
Citizenship
Register to vote
Join a community-based organization (church, PTSA, Neighborhood Watch, etc.)
Citizenship
Register to vote
Join a community-based organization (church, PTSA, Neighborhood Watch, etc.)
Hidden
Financial Literacy
Complete loan/credit application
Open or access a checking account
Open or access a savings account
Understand banking and/or credit process
Financial Literacy
Complete loan/credit application
Open or access a checking account
Open or access a savings account
Understand banking and/or credit process
Hidden
Legal
Complete a legal document
Seek legal advice when necessary
Seek online information on employment rights
Seek online information on housing rights
Legal
Complete a legal document
Seek legal advice when necessary
Seek online information on employment rights
Seek online information on housing rights
Health Literacy
Use digital medical resources (WebMD/Telemedicine)
Use health care facilities and services
Registered for a Covid-19 vaccine or booster
Other computer skill or task(not listed): briefly describe
Section 3: Overall Experience
Next appointment scheduled?
(Required)
Yes, scheduled with volunteer
No, will schedule library staff
No, not needed yet
Did not provide a response
Was the outcome achieved?
(Required)
Yes, the outcomes(s) was achieved
Requires more time, customer will complete it independently
Requires more time, customer will return for more help
No, Could not find a solution to achieve the outcome(s)
Received USB Drive
(Required)
No, not required
Yes
No, previously received a USB drive
Please describe your interaction today
Volunteer work notes
Section 4: Sharing Your Success
We would like to highlight the work our program and our volunteers are doing to support the individuals in our community. Please consider sharing your success to help others see why we do what we do. You measure your own success, we are here to help you get there.
Would you be willing to share your story?
(Required)
Yes, I will complete the contact information below
No. I do not wish to share my story publicly
Not at this time, but I am willing to be contacted in the future to share the outcomes of my work with the volunteer
I have already submitted my story/contact information
Phone Number
Personal Email
Please share some details about yourself and what your goals or successes are.
Some ideas: Job searches and employment opportunities, education goals achieved, learning a new language, finding better housing, applying to a program or service and being accepted, community involvement, etc.
Name
This field is for validation purposes and should be left unchanged.
Username or Email Address
Password
Remember Me
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