Mini Lab Application

To apply for a PCF mini-lab, please fill out the form below. We value your privacy and will not share your information with anyone!
Program Information
Program Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Region*
Please select your region so we can route this form accordingly.
Contact Name*
First Last
Contact Phone*
Contact Email*
Are you part of, or affiliated with, a school?*
- Yes
- No
School name
Contact name
Contact phone
Usage Information
Please tell us about your location and whom it serves*
What will the computers be used for?*
Who will use them? What will they use them for? How often will they be used?
Tell us if and how the computers will be supervised*
Please tell us what you need*
How many are you looking for? Desktops or laptops? Do you have any computers now? Do you have a printer? Anything else?
Please describe your/your staff's proficiency with computers*
Room / Connectivity
Does the location currently have internet?*
- No internet
- Comcast (regular)
- Comcast Internet Essentials
- Verizon
Do you have a table for the computer/s?*
Also, is there power nearby?
How close is the table to the internet modem?
We typically run one cable from the router to the computers.
Upload photo #1
Please show us the room if you can.
Upload photo #2
(upload another photo if you'd like)
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Program Information