Student Tech Connection Program Application
Student's First Name
Student's Last Name
School Attending
Grade Level
Please briefly tell us how a computer will benefit you as a student and what you'd like to accomplish.
Parent/Guardian Information
Parent/Guardian First Name
Parent/Guardian Last Name
Parent/Guardian Email
Parent/Guardian Phone #
Parent/Guardian Address
COMPUTERS NOT PICKED UP WITHIN 10 DAYS WILL REQUIRE A NEW APPLICATION BE SUBMITTED
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