You must
live in the Grand Rapids Area to qualify for a computer. Please print and mail this
Application along with the
School Performance Form &
Volunteer documentation to:
Bill and LaVerne Blickley
1312 Dunham SE,
Grand Rapids, MI 49506
1. Name the person who will be the main user of the computer in your family: _________________Grade_______
2. Please PRINT the full name the parent or other adult who will supervise the
use of the computer. First ___________________ Middle ___________________ Last ________________________
3. Your Address:
____________________________________Zip Code______________________
4. Home phone
#: ___________________ Work Phone #: __________________Cell Phone
#:__________________
5. Do you want to use your computer to access the Internet? _____
Do you want to have e-mail? _____
6. Are you aware that the use of the Internet by children should be supervised?
__________
7. Are you aware that you can control the use of the Internet by a secret password known only to you?
__________
8. Will you use your computer for games? _____ School work? _____ Family & personal work? _____
9. The computers that we give have an Office* type program.
OpenOffice
will open
and convert to all Microsoft Office Program files and PDF and HTML files,
too.
10. How did you find out about this program?
_____________________________________________________
11. Please list
other students in your family:
Name:
_______________________ Age ____ Grade _________ School
_______________________________
Name: _______________________ Age ____ Grade _________ School
_______________________________
12.
** Please submit your volunteer service
confirmation letter and school form
with this application. **
Please
click here to get instructions that the non-profit must have to
document
your volunteer service. *Community Service credit for obtaining a computer may be completed by members of your family at a church, school, neighborhood association, or any combination
of community non-profit organizations of your choice.
School attendance and academic effort may determine the priority of delivery of computers to applicants.
***
Please have your school fill out the
School
Performance form. *** Please have
a statementconfirming completion of your ten (10) hours of service
...with your application. The statement must be on official stationary telling what volunteer work was
done, when done, and hours
completed.
The volunteer hours must be done specifically to earn credit for a computer.
** Parent
/Guardian /College Student Signature: ___________________________ Date____________
To
assure that your community work has been done, we must also receive
a letter of confirmation from the organization you served. Click
here for excerpts of letters from organizations confirming volunteer hours done by a student and their family for a computer. It is required that these letters be on official stationary and include the date that the work was done,
hours completed, student's phone #, and a description of the work. The letter must be signed by the supervisor.
Don't know where to volunteer so you can qualify for a free Computer?... Call
211 or Click
Here
