Laptop Lending
Program Application

Student ID Number(Required)

Name(Required)

First Last

Cell Phone(Required)

Home Phone

College Email(Required)

Personal Email

Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Campus Location(Required)

Do you currently have access to a computer?(Required)

Yes

Do you have access to the internet?(Required)

Yes

Are you eligible or currently receiving Pell Grants?(Required)

Yes

In 300 words or less, share your need for the computer, your goals for the future, and how it will benefit you academically(Required)

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