Technology Assistance Program Form – Parker Street Food and Furniture Bank

Technology Assistance Program Application Form

Date of Application

First Name

Last Name

Date of Birth

ID Number (last four digits only)

ID Type

Street Address

City

Postal Code

Phone Number

Who will be the primary user of the computer that you are applying for?

What will be the primary use of the computer you are applying for?

If other, please describe:

Does your household have other computers or computer equivalents?

If yes, please describe:

Do you have access to the internet?

In 250-500 words, please describe why you need a computer and how receiving a computer will benefit you. Please note this essay is an important part of the application process.

Along with this application, please submit the following supporting documents. An application cannot be processed without this information. This information will be kept confidential.

Proof of Income (for the entire household). This includes, but is not limited to: pay stubs, T4s, CPP, Social Assistance stub, child tax benefits, etc. If no income, please submit a bank statement showing no significant deposits in your account for the past month.

Proof of Address. Please submit an official document with your name and address visible. This could be a bill with your address, a lease, government issued mail, etc.

Confirmation of Enrolment in School or Confirmation of Employment.

I confirm that the information included in this application is accurate to the best of my knowledge and that I understand completion of this form does not guarantee approval.

Technology Assistance Program Application Form

Date of Application

First Name

Last Name

Date of Birth

ID Number (last four digits only)

ID Type

Street Address

City

Postal Code

Phone Number

Who will be the primary user of the computer that you are applying for?

What will be the primary use of the computer you are applying for?

If other, please describe:

Does your household have other computers or computer equivalents?

If yes, please describe:

Do you have access to the internet?

In 250-500 words, please describe why you need a computer and how receiving a computer will benefit you. Please note this essay is an important part of the application process.

Proof of Address. Please submit an official document with your name and address visible. This could be a bill with your address, a lease, government issued mail, etc.

Confirmation of Enrolment in School or Confirmation of Employment.

I confirm that the information included in this application is accurate to the best of my knowledge and that I understand completion of this form does not guarantee approval.

Technology Assistance Program Application Form

Date of Application

First Name

Last Name

Date of Birth

ID Number (last four digits only)

ID Type

Street Address

City

Postal Code

Phone Number

Who will be the primary user of the computer that you are applying for?

What will be the primary use of the computer you are applying for?

If other, please describe:

Does your household have other computers or computer equivalents?

If yes, please describe:

Do you have access to the internet?

In 250-500 words, please describe why you need a computer and how receiving a computer will benefit you. Please note this essay is an important part of the application process.

Proof of Address. Please submit an official document with your name and address visible. This could be a bill with your address, a lease, government issued mail, etc.

Confirmation of Enrolment in School or Confirmation of Employment.

I confirm that the information included in this application is accurate to the best of my knowledge and that I understand completion of this form does not guarantee approval.

Technology Assistance Program Application Form

Technology Assistance Program Application Form

Technology Assistance Program Application Form

PARKER STREET FOOD
& FURNITURE BANK

Parker Street Food
& Furniture Bank

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