Application for Receiving a Computer
Name :

Address :

Contact Number :

Email Address :



1. Concerning the computer you are presently using at home , check all that apply .












Do not have a computer at home


2. How many people in your household know how to use a computer ?







3. For what purposes will a computer be used ? Check all that apply.
Homework
Writing reports / word processing
Research
Games
Storing photos
Watching movies



In addition to submitting this request online , please download this support document , complete it and return it to us via email , fax or regular mail. Your request will not be acknowledged unless the document is completed.


 

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