COPS AND COMPUTERS FOR THE COMMUNITY 

                   Changing lives, one computer at a time...

 

 
 

 

 

 

 

 

 

Media center

Special Events

Our Projects

Feedback

Clients Responses

Guest book

Partners

Links

Volunteer now

Contact Us

 

  PC Grant Application

    
 
To receive your computer grant, please fill out the following form in it's entirety.  If this grant application is for a minor child under the age of 18, information for both the adult and the minor child is required.

     In a grant request where a minor child will be the beneficiary, an adult or legal guardian for the minor child will actually be receiving this computer on behalf of the child.  In such cases, information is also required about the adult or head-of-household in order that we may properly effect the transfer of ownership.

Grant Application Information....

Applicant Full Name:      ( Adult )
Email Address:  
Address Line1:  
Address Line2:  
City, State, Zip Code:  
Home Phone:  
Your Date of Birth: Mon -  Day -  Yr -
     
     
Complete below information if the computer

is to be received by a child under 18 years of age.

     
Name of Minor Child:  
 Age of the Child:  
School Attended:  
Parent's Names:  
   
Parent's Occupation:  
   
 Annual Household Income:  
 
Why I Want A Computer Essay  (Required..)

In your own words, tell us why you should be given a free computer.  Explain how the computer will be used and the ages of the users.

                                      

 

Partners in Progress

            

Copyright © 2003.Webmaster. All rights reserved

Home

About us

Ways to help

Projects

Media

PC Request

Partners

Volunteer

Contact us