SD Oasis Tablet Program Application

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Thank you for your interest in the San Diego Oasis Tablet Program. The goal of this program is to encourage connection and community through technology. Eligible low-income older adults will receive a new, specially configured Galaxy Tab A tablet, internet connectivity, training in the use of the tablet, and access to San Diego Oasis classes.

Statistical and demographic information is used in applications for grant funding. The following information will be held strictly confidential.

Eligible low-income older adults in San Diego County will receive a Samsung Galaxy Tab A tablet.

First Name *

Last Name *

Phone Number *

Email Address - A Gmail account is required to operate the tablet, if you already have a Gmail account, please list it. If not, please list your existing email address. A Gmail account will be created for you as a device requirement. You can still use any existing email addresses. If you do not have an email address, type "NA". *

Street Address *

City *

Zip Code *

Date of Birth *

YYYY

Community/Housing Organization (Please list the facility where you reside or the organization who referred you to the program.) *

Gender *

Male

Female

Prefer not to say

Other:

Ethnicity *

African American

Asian

Caucasian

Hispanic

Native American

Prefer not to say

Other:

Are you a Veteran? *

Yes

Do you live alone? *

Yes

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