Computer Request Form

Computers for Schools

Request for Computer Equipment

Organization Name:__________________________________

Registered Charity Number:____________________________

Contact Name:_____________________________________

City:_______________ Province: _______________________

Email:_____________________ Phone: (__)_______________

---

Please complete the following:

1. What is the population of your client base?____________
2. How much equipment are you requestion?

   ____Computer & Monitor	____Printers
   ____Computers Only	____Monitors Only
   ____CD Burner (if available)	____Other Items (please specify) _______________

3. Please describe the utilization plan of computers made available under this program:
   ____________________________________________________________________
   ____________________________________________________________________
   ____________________________________________________________________

 

Name of Executive Director:_____________________________________

**In signing for computer equipment, I acknowledge that equipment will be used for purposes described in part 3, and will NOT be used as a fundraiser/raffle item, nor sold for profit.

Signature:___________________________ Dated:_____________________________

Computers for Schools - 155 Queen Street, 4th Floor
Ottawa, ON K1A 0H5
Phone: (613) 998-1804 - Fax: (613) 957-1201
Email: gagnon.robert@ic.gc.ca
http://cfs.ic.gc.ca

Computer Request Form (PDF, 36 KB)
About PDF Files