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1
Full Name
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First Name
Middle Name
Last Name
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2
Email Address
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example@example.com
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3
Phone Number
Please enter a valid phone number.
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4
Preferred Contact Method
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Email
Phone
Text Message
Other
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5
Organization / Business
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6
County
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7
AI experience level
*
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No experience
Beginner
Intermediate
Advanced
Expert
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8
AI tools currently used
ChatGPT
Microsoft Copilot
Google Gemini
Claude
Perplexity
Midjourney
DALL·E
Other
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9
AI topics and applications of interest
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10
What do you hope to gain from this cohort?
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11
What barriers might affect your participation?
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12
Anything else we should know
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13
I agree to commit to the full four-week cohort
*
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Yes
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14
I agree to attend the weekly in-person sessions
*
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Yes
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15
I agree to complete all coursework and understand seats are limited
*
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Yes
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16
This information is required to support free programs and may be used for funder reporting. Your responses will be kept confidential where possible.
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17
Household Size
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18
Employment Status
*
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Please Select
Employed full-time
Employed part-time
Self-employed
Unemployed
Student
Retired
Homemaker
Prefer not to say
Other
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Please Select
Employed full-time
Employed part-time
Self-employed
Unemployed
Student
Retired
Homemaker
Prefer not to say
Other
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19
Annual Household Income Range
*
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Please Select
Less than $25,000
$25,000–$49,999
$50,000–$74,999
$75,000–$99,999
$100,000–$149,999
$150,000 or more
Prefer not to say
Please Select
Please Select
Less than $25,000
$25,000–$49,999
$50,000–$74,999
$75,000–$99,999
$100,000–$149,999
$150,000 or more
Prefer not to say
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20
Driver's License or State ID Number
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21
Last 4 Digits of National Identifier
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