Kids Tech-Connect Nomination Form
Fill out this form to nominate your student to receive a free Chromebook. If your student is selected, you will receive instructions for retrieving the laptop for your student in an outdoor public location in Jersey City. One form per student only. You may nominate up to three students. The nomination deadline is January 29, 2021, at 5:00 p.m. For inquiries, email us at cudacultureinfo@gmail.com, headline "CUDA Tech-Connect Project."
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Email *
Name of School or Organization *
Last Name *
First Name *
Phone # where we can reach you during the day: *
Title/Position (i.e. Public School Teacher, School Counselor, Social Worker, Coach, Principal, Youth Mentor, Dance Instructor, etc...) *
Student's Last Name *
Student's First Name *
Grade Level *
Required
Why do you think this student is a great candidate for this project? (Please answer in no more than 200 words.) *
How will this new laptop be useful to your student? (Please answer in no more than 200 words.) *
Student's Parent/Guardian's Full Name *
Student's Parent/Guardian's Phone # and Email:
By applying to this project, you agree that you have informed the parent/guardian of the child that you are nominating the child for a free laptop.
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Winners will be selected by the CUDA committee and notified by email and/or by phone in the week of February 15, 2021. CUDA Culture will not share any of your information with a third party. CUDA culture will not be responsible for any laptops distributed to the designated recipients. CUDA Culture does not discriminate based on certain protected characteristics, which include, but are not limited to race, creed, color, national origin, sexual orientation, gender identity or expression, sex, and disability. By completing this form, you agree that you understand the statements and expectations outlined above. Complete the date below to finish your form and click submit. Thank you for your participation.   *
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A copy of your responses will be emailed to the address you provided.
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