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School Performance Form

This Student Attendance & Effort Report can help students (7th grade through College)
receive a Free Computer.


I request that _______________________________ provide the information requested below so that your student
                     (Name of school - Please print -)
_________________________________ may receive a computer by participating in the program described below.
(Name of student - Please print - )

Signature of parent/guardian, or college student : ___________________________ Date _____________

Printed name of parent/guardian or college student: ___________________ Home Phone :_________ Work Phone ____

1. Name of student applying for a computer: _______________________________________ Grade __________

2. Name of School ________________________________________________________

3. Address of school _______________________________________________________

4. Is the named student attending your school? ____________

5. Number of unexcused absences from school in the past marking period: ____________

6. Number of unexcused times late for class in the past marking period: ______________

7. Is this student working at or near their academic ability? ______________ Grade point average ___________

Signature of school representative: ___________________________ Title: ______________ Date ___________

Printed name of school representative: ________________________ Phone: _____________________

 
This program is for students...7th grade and above, including college students       

        We are preparing a good used computer for the student that will allow a connection to the Internet, (with 6 months of free Internet service) adequate memory and processor to make the computer run well, a sound card to let the student hear sound, if they get speakers connected to the computer, and adequate storage space for the software programs installed, and school assignment documents.
        The student can chose to have an"Office" ...*type Software...* installed on their computer.  The program provides tools for word processing (writing letters and school papers), spreadsheet (doing accounting type work), and a database (organizing lists of people and things).

        * The version of this software is nearly the same and compatible with the programs used by students in local schools. 

Please print and hand deliver or mail this application to: Bill and LaVerne Blickley, 1312 Dunham SE, Grand Rapids, MI 

 

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.     Don't know where to volunteer?... Call 211 or  Click Here 
 It is required that these letters be on official stationary and include the date that the work was done and a description of the work.  The letter must be signed by the supervisor. 
Click Here to get instructions for writing the letter.