To qualify for a computer...You must complete ten (10) hours of Service to your community.
Please click here to get instructions that the non-profit must have to document your volunteer service. 

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  access the Internet? ____         and  are installed on this computer.

Do you have  a high speed Internet connection, or plan to get one soon?  ____________      (AT&T, Comcast, etc.)
Do you have a "phone line" telephone? _____________ Our free Internet requires a phone line to your house to work.
6. The use of the Internet by children should be supervised!  Click here >>>>>
7.  Get reports about the Internet use of this computer!        
     Both Covenant Eyes and Church.com can monitor computer Internet use and regularly send you an e-mail report .

8. Will you use your computer for  School work? _____ Family & personal work? _____
9. We install Windows XP, and Microsoft Office 2003 (Updated 09) on the computers as a         

   We also install the latest OpenOffice program             
  OpenOffice will open and convert to all Microsoft Office Program files and PDF and HTML files, too.

  Read an article comparing the newest Microsoft Office programs to OpenOffice programs.  
Note:  If you wish to have another specific program installed on your computer... please let us know and we'll see if we have it.
         

11. How did you find out about this free computer program? ____________________________________________

12. Please list other students in your family:

Name: _______________________ Age ____ Grade _________ School _______________________________

Name: _______________________ Age ____ Grade _________ School _______________________________

13. ** 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 statement confirming 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____________