Thank you for your interest in the ecommute Pilot Program. Please provide the following information so that we may add you to our mailing list.

 Please assign your username and password for future profile update
  User ID: (8-character, case sensative) Password: (up to 8-character, case sensative)
 

 
 Employer Contact
  First Name: Last Name:
 

  Title: Department:
 

  E-mail address: Phone Number:
 


(format xxx-xxx-xxxx)
 

 Telecommuting Program Contact (If different than above)

  First Name: Last Name:
 

  Title: Department:
 

  E-mail address: Phone Number:
 


(format xxx-xxx-xxxx)
 

 Organization Information

  Organization name:
  Address:

  City: State: Zip:
 

  Comments:

 
 

How many employees are in your organization?

 
 

Please classify your organization.

 
 

Does your organization currently offer a telecommuting program for your employees?
Yes (please answer 3a & 3b) No (please answer 3c & 3d)

3a. If YES, how many employees are actively telecommuting?

3b. Majority of the employees telecommuting are -
part-time workers full-time workers

3c. If NO, does your organization plan to set up a telecommuting program in the next

3d. How many employees would you expect to participate?

 

What is (or would be) your telecommuting applications?
Word processing; Accounting; Data entry; File sharing;
Document preparation; Creative writing; Graphics; Telemarketing;
Other, please indicate

 

What is (or would be) your primary telecommuting communications link?
56k modem; DSL/Cable modem; T1 line; Dedicated line;
Delivery service; Postal service; Personal trips to office

 

What percentage of the telecommuting work force is (or would be)
% - working at home
% - working at satellite office(s)
% - working at telework center(s)
% - other, please indicate

 

On average, how many days a week do (or would) your employees telecommute?

 

Please indicate your current status in the ecommute pilot program:

(mm/dd/yy) Original contact date
(mm/dd/yy) Follow-up contact date
Yes No Attended orientation meeting
Yes No Formally applied to program
Yes No Issued User ID
Yes No Received implementation materials
Yes No Received employee training
Yes No Program operational
Numbers of employees in program

 
Yes, I want our organization to participate in the ecommute Pilot Program. Please provide us with information on how to proceed.
Yes, I want to receive e-mail announcements about future telecommuting programs.
Yes, I want to participate in future telecommuting surveys and research projects.