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10X PROGRAM-DIGITAL MARKETING MASTER CLASS FOR BUSINESS
SECTION 1: PERSONAL INFORMATION
First Name
*
Second Name
*
Phone Number
*
Email
*
Date of Birth
*
District/Area of residence
*
Highest level of education
*
Highest level of education
A
No formal education
B
Primary
C
Secondary (O-level)
D
Secondary (A-level)
E
Vocational/technical
F
University/College
SECTION 2: DIGITAL STATUS
Digital Literacy Level (Select one):
Untitled multiple choice field
A
Beginner (I can use a phone but limited on apps)
*
B
Intermediate (I can use social media, email, and basic online tools)
C
Advanced (I can work on digital platforms, create content, or do online jobs)
Gadgets You Own (Tick all that apply):
*
Gadgets You Own (Tick all that apply):
Smart phone
Laptop
Desktop computer
Tablet
None
Internet Access:
*
Internet Access:
A
Regular (daily access)
B
Occasional (few times a week)
C
Rarely
D
No access
SECTION 3: EMPLOYMENT AND SKILL STATUS
Current Employment Status:
*
Current Employment Status:
A
Employed (Full-time)
B
Employed (Part-time)
C
Self-employed
D
Unemployed
E
Student
Do you have any experience in digital work?
*
Do you have any experience in digital work?
A
Yes (Please specify below)
B
No
Specify experience in digital work (If Yes above)
*
SECTION D: MOTIVATION & CONSENT
Why do you want to join the 10X Program?
*
How did you hear about this program?
*
How did you hear about this program?
A
Social Media
B
Friend/Family
C
Community Leader
D
Other (Specify): __________________________
Consent: I hereby declare that the information provided above is true and accurate.
I agree to participate fully in the 10X Program activities.
Signature
*
Signature
Date
*
Submit
