Internet Connectivity Application Form

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This application will take 5 minutes to complete.

This survey is submitted to Fairbanks Community Parent Teacher Association (FCPTA) and reviewed by FCPTA and Bright Futures Fairbanks. In submitting this application you agree to have the answers released to FCPTA and Bright Futures Fairbanks.

*Do not cancel home internet access to qualify for free internet.

Email *

What is your phone number? *

What is your email address? *

Does your family currently have internet? *

Yes, from a cell phone

Yes, but it does not meet our household internet needs

Yes, but it is a financial burden.

Other:

Do you have an outstanding balance with an internet provider? Please note that this does not disqualify families. *

Yes

Does your student attend school in-building? *

Yes

Other:

Is your student a high school junior or senior? *

Yes

For high school student only, will your student be doing ELearning over the summer?

Yes

Maybe

Clear selection

Do you qualify for internet funding through Tanana Chiefs Conference?

Yes

Maybe

Clear selection

Please list the names of students in your household. *

Anything else you would like us to know? *

Your application will be reviewed for a donation and service match. For communication during the review process, what is the best way to reach you? *

Submit

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