Mobile Technology Grant Application

Name (required)

Organization’s Legal Name (if applicable)

Mailing Address (required)

City (required)

State (required)

Zip (required)

Main Telephone Number (required)

Fax Number

Title (required)

Phone (required)

Email (required)

Additional Contact Name

Additional Contact Title

Additional Contact Email

Why are you applying for the Conover Mobile Technology Grant? (required)

How will this technology help you or someone you care about? (required)

Why should you receive this grant? (required)

How will you use this technology?

Any other relevant information

If you are a recipient of this grant, are you willing to share your success story with others? (required)

What type of mobile device are you applying for? (required)
iPod touch
iPad

Comments

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