Mini Lab Application

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?*

School name

Contact name

Contact phone

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*

Does the location currently have internet?*

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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