Organization Name Address City State Zip Phone   Fax Email Address School District Grades Served Percentage of students eligible for free/reduced-price lunch program   Public School     Private School     Parochial School Nonprofit organization (501(c)(3) only) EIN* *If you are a not-for-profit we can not deliver computers without the employer identification number. Questions or Comments     DESIGNATED CONTACT - COMPUTERS FOR SCHOOLS PROGRAM: Name Email Phone Title Affilliation The following individual(s) will be primarily responsible for the initial hook-up of the computer(s) and their correct usage. These persons are trained in computer setup, repair and maintenance; will assist with installation of curriculum software as necessary; and will be available to the school for consultation and troubleshooting, if needed. Name Email Phone Title Affilliation Name Email Phone Title Affilliation SECTION TO BE COMPLETED BY TOP ORGANIZATION ADMINISTRATOR: I certify that my organization has a Technology Plan, which can accommodate the effective use of refurbished computers obtained through the Computers for Schools Foundation. This plan will provide a significant benefit to teachers and students and will integrate software into age-appropriate curriculum. Our teachers will encourage creative use of the computers for instruction, and will provide basic skills training for students. My organization is dedicated to continual enhancement of teacher training in the effective use of computers in the classroom. We have adequate security for the computers. Name Phone Email Date

Computers for Schools Contact Information
Andrew J. Vass
PO Box 2426
Northbrook, IL 60062
Phone: 847.909.7500
Fax: 847.205.7267