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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 :________________ Cell 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 adult education, GED, on-line and in-class 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 dial-up 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.
    
We offer Internet monitoring and filtering software to the families to protect their students:  

We place computers in homes of students that could not otherwise afford one .
If you would rather not wait for us …. and can afford to buy a good used computer...
  Call: 245-7097, or 454-3060

The computers that we give to high school and college students have a operating system and "Office"  type programs.  This provides word processing (writing letters and school papers),
 spreadsheet, (doing accounting), and database, (organizing lists of people and things).
 
We install 2007 (updated 2011) and

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. 
   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.