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Application for a Computer - Organization
Application for Computer
Non-Profits, School/Educational, Faith Based Community Services
All 501(C)3 not-for-profit, Public or Private Schools, Faith Based community services and libraries are also eligible for computers as well as servers, networking equipment, overhead projectors, laser jet printers or other hardware we might have on hand.
Please complete the online application form. Non-profits please upload a scanned copy of your IRS determination letter.
Date
*
Telephone
Organization Type
*
-None-
Faith based community service
Private School
Public School
Non-Profit
Please attach IRS determination letter or other documentation
Organization Name
*
First Name
*
Last Name
*
Street
State
City
Zip
Title/Position
Fax
Email
*
Mailing Address
if different
than above
General Description
of Community
Services Provided
Demographic Info
-None-
Family
Individual
Student(s)
Senior 62+
Clients served yearly
Hour(s)
Individuals
Description of Equipment
or Services Requested
Lead Source
-None-
Board Member Referral
Telephone Call Into CTAC
Web Application - Individual
Web Application - Organization
Web Donation Form
What will the
equipment be
used for?
Upload IRS or other determination info
Max File size limit is 20MB
I herby certify that the above is true and correct
Sign Here
*