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BootUp Community Empowerment TechDrop
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* Indicates required question
Full Name:
*
Your answer
Email
*
Your answer
Phone Number
*
Your answer
Current Address
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Educational Background
*
What is the highest level of education you have completed? What have you studied and most interested in educationally?
Your answer
Current Occupation Status
*
What is the highest level of education you have completed? What have you studied and most interested in educationally?
Self Employed - Full Time Entrepreneur
Unemployed
Employed Part-Time
Employed Full Time
Current Educational Status:
*
What is the highest level of education you have completed? What have you studied and most interested in educationally?
Actively Enrolled and in school
Actively Looking to enroll
Graduated/Finished School
Currently in a professional learning program
Currently looking for a professional learning program
Describe your current tech access and how it impacts your goals:
*
(lack of a computer, limited internet access, etc.)
Your answer
Describe your financial situation and why you require assistance:
*
(lack of a computer, limited internet access, etc.)
Your answer
What are your educational, entrepreneurial, or career goals?
*
Your answer
Which device are you most interested in receiving?
*
Choose
Android Phone
Desktop Computer and Monitor
iPhone
iPad
Laptop
How do you believe this tech device will assist you in achieving these goals?
*
Your answer
Have you previously owned or used the tech device you are requesting? If yes, please describe your experience.
*
Your answer
How do you plan to contribute to your community upon achieving your goals?
*
Your answer
Are there any specific software or technical skills you wish to acquire?
*
Your answer
Reference: Please provide the name and contact information of a non-family member who can vouch for your character and commitment (e.g., teacher, mentor, employer).
*
(e.g., teacher, mentor, employer).
Your answer
Additional Comments: Is there anything else you would like us to know about your situation or your aspirations?
(e.g., teacher, mentor, employer).
Your answer
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