Digital Resource Fair Registration Form

Indicates required field

Basic Information

Age
Origin (check all that apply)

Digital Resources

Do you have internet at home?
Are you aware of the Affordable Connectivity Program?
Do you currently own a computer or tablet?
If no, have you previously owned a computer or tablet?
How comfortable are you with technology skills?
Are you aware of any organizations in Eau Claire County that work on...
Broadband (high-speed internet) affordability issues?
Broadband (high-speed internet) expansion to underserved/unserved areas?
Digital skills (technology) training?
Availability of free or low-cost devices?

Services

Please check all the services you will use at this event. Check all that apply.

Eligibility

Your household is eligible if you are at or below the 200% Federal Poverty Line OR on certain governmental assistance programs (such as SNAP, Medicaid, WIC, Pell Grant, Free/Reduced Lunch, or other qualifying federal programs). If you have any questions about your eligibility please call Amber Scharenbroch at (715) 834-5043.
Check any special circumstances that apply.
Check any specific eligibility criteria that applies. If none apply, you are ineligible for the ACP or a $30 device. (check all that apply)
Are you eligible for the ACP or $30 device? (Did you have something checked in the question above?)
Certification
You are ineligible for the ACP or the $30 device. This mean you cannot use the following services at the event:
  • Affordable Connectivity Program (ACP) Enrollment
  • Purchasing of an Affordable Device ($30)

 

Affordable Connectivity Program Information

Which internet service provider do you want to use your ACP credit with?

Affordable Device Information

**You will need to bring cash or check with you to pay for your $30 device at the event.**
Which type of computer do you want to purchase?
Example of a laptop:                      Example of a desktop:      
                    
What will the computer be used for? (check all that apply)
Liability

Internet Service Provider Information

Which internet service provider onsite do you wish to speak with? (select all that apply)

Digital Skills (Technology) Training Information

What type of device do you need training on? (select all that apply)

Photo Release

I agree on my behalf of myself and my children that we may be photographed, recorded, and videotaped by United Way of the Greater Chippewa Valley, its employees, partners and affiliates or any media without receiving compensation of any kind. I give United Way of the Greater Chippewa Valley, its employees, partners, and affiliates the right to edit, use, and reuse these photos as for future publications.