Computers for Schools – NWT

First Name: ____________________ Last Name: _______________________ ⁭ Male ⁭ Female

School/College/University do you attend: ________________________________________________

Grade/Program: ____________________________________________________________________

Name of Principal/Teacher: ___________________________________________________________

Contact Name: _____________________________________________________________________

Home Address: ____________________________________________________________________

(if minor, give parents/guardian address)

City/Community: _________________________ Prov. /Terr.: ________ Postal Code: ____________

Phone: (________) _________________________ Fax: (________) __________________________

E-Mail: ___________________________________________________________________________

Please Note:

The computer hardware made available through CFS will be mainly equipped with Windows XP operating systems provided you accept the Microsoft Licensing Agreement.
While Computers for Schools undertakes to provide a functioning computer, any subsequent liabilities or repairs are the sole responsibility of the recipient after having been in receipt of the equipment for three months.

Please Complete the Following:

1. Type of computer platform requested (please check one box):

“ IBM/Clones only* “ Macintosh (if available)

*I accept the Licensing Agreement for Windows 2000 between Microsoft and Industry Canada “

2. How many computers are you requesting _____Desktop ____Laptop (if available)

3. Please describe what this equipment will be used for?

“ Special needs students “ Curriculum support “ Internet research

“ Upgrading hardware “ Co-op projects “ Multimedia “ Library use

“ Word processing “ Administrative applications “ Classroom management

Other: ______________________________________________________________

Signature of Student: _____________________________ Date: ____________________________

Signature of Parent/Guardian: ______________________________ Date ______________________

Please fax completed form to: 867-766-3983

CFS-NWT Workshop Location

5003-48th Street Basement Suite

Yellowknife, NT Canada X1A 1N4