Application - kids@computers

26-0135 2012 - 12 Application kids@computers Scholarship Project Please print Please indicate what type of Social Benefits you are receiving Ontario Works ODSP Please attach verification if one of these 3 boxes are checked Subsidized Housing or NCBS Recipient or Welcome Policy Member Child's Information (Must be 8 14 years old) First name Last name Date of Birth (yyyy-mm-dd) Home address Apt. no. Buzzer code Postal code Home telephone # Parent(s) or guardian(s) living with the child First name Last name First name Last name If the child has any siblings between the ages of 8-14 living at this address, please list below: First name Last name Date of Birth (yyyy-mm-dd) Would your child need any support(s) in order to take part in a classroom setting? No Yes Your child should use the space on the back of this Application to tell us the reason(s) they need a computer in their home. Does your child currently have access to a computer in your home?

Application Checklist The child applying must live in Toronto and be 8 to 14 years of age. Please complete all areas of the application. The parent(s) / guardian(s) must currently receive one (or more) of the following: Financial

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