Facility/Individual Sign Up

Facility/Individual Sign Up
Welcome to Teens Teach Technology, we are so excited to work with your community! Please fill out this form which should take about 5 minutes. If you haven't already, check out our website.

If you have any inquiries, please do not hesitate to email us at exec.teensteachtech@gmail.com.

We will get back to you within 2-4 business days.

This form has 4 sections:

1. General Information

2. Type of Lesson

3. Scheduling Times/Days

4. Confirmation

General Information
Name*

First NameLast Name
Email*
example@example.com
City, State*
Full Facility Name*
Write N/A if you are an individual.
Type of Facility*

LibraryNursing HomeSenior CenterAssisted Living FacilityN/AOther
Virtual or In-Person?*

Virtual (Zoom)In-Person (based on volunteer availability by location)Other

Confirmation
I confirm everything that I filled in this form is correct to my knowledge*

Yes
I have rechecked my email to make sure it is filled in correctly.*

Yes
Is it okay if we take a picture at the end of the lesson(s) for our website/social media?*

YesNoOther
Where did you hear about us from?*
Should be Empty: