Application for the 2010 California Digital Inclusion Program

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If you are interested in applying for no-cost technical assistance and consulting to make accessibility improvements to your website, please fill out the form below. Organizations that participate in the California Digital Inclusion Program will be expected to commit an average of 5 staff hours per month between at least April and October 2010 and commit to implementing at least one accessibility improvement on their website during that time.

Organizations successfully completing the Program will be eligible for 2010 California Digital Inclusion Awards.

If you have questions, please contact Jon Mires at the Center for Accessible Technology: jmires@cforat.org or 510-841-3224 x117.

Please note: Contact information will be used solely for following up with interested organizations and will not be shared with anyone.

1. Organization name: Required Question

2. Organization website address (URL):
Required Question

3. Mailing address: Required Question

4. What does your organization do? Required Question

5. Name of person completing this form: Required Question

6. Title of person completing this form: Required Question

7. Name of person to contact for follow-up information: Required Question

8. Title of follow-up contact: Required Question

9. E-mail address of follow-up contact:

10. Phone number of follow-up contact: Required Question

11. How many average visitors per month does your website receive?

12. What prompted you to apply to the California Digital Inclusion Program?

13. What accessibility improvements are you interested in making: Required Question

	Access for blind users
	Access for low vision users
	Access for people with learning disabilities
	Access for people with mobility impairments
	Improve access to a specific page or process on our site
	We're not sure - we'd like assistance choosing an appropriate project
	Other:

14. How did you hear about the California Digital Inclusion Program? Required Question

By submitting this application, you confirm that to the best of your knowledge:
1. You organization is based in California or providing products/services to Californians;
2. Your organization is willing to devote an average of 5 staff hours per month between April and October 2010;
3. Your organization agrees to implement at least one accessibility improvement between April and October 2010.

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