Application For A Sparky's Kids Computer & Printer
Your First Name:
Your Last Name:
Your Guardian's First Name:
Your Guardian's Last Name:
Street Address:
City
State:
Zip:
Email Address:
Home Phone:
Guardian's Day Phone:
Please answer the following questions. If you need additional space, write the question and your answer on a separate piece of paper.
How old are you?
What grade are you in?
What school do you attend?
If you are a member of the Boys & Girls Club, what club are you a member of?
How did you hear about Sparky's Kids?
Do you currently use a computer at your home?
Yes
No
Do you currently know how to use the computer?
Yes
No
If so, what computer software programs do you know how to use?
What computer programs would you like to learn how to use?
Specifically, what would you use the computer for?
If you owned your own computer, how much time per week do you think you would use it?
Hours
How do you think owning your own computer will improve your life?
What grades did you make for each of your classes on your latest report card?
Are there other members of your family that would also be able to use the computer?
Yes
No
If so, how would they use it?
Is there anything else you would like Sparky’s Kids to know about you?
