Welcome to Computers For Children

Computers for Children Kidco Application

	Student First Name			Student Last Name			Date

Address

City	State	Zip

	Home Phone	Alternate Phone

	Parent's Name

	Parent's E-Mail

This program is for students of households with Demonstrated Financial needs.

	Parents - Annual Household Income

The following information is required by our funders for statistical purposes only.
In order to continue to keep the program free to students and families, we must collect this data.
Please choose one of the following ethnicities below.

	White	Black/African American
	Hispanic/Latino	Asian
	Pacific Islander	American Indian/Alaskan Native
	Two or more races

	School Attending	Current Grade

	Age	Student's Date of Birth

Number of Children in the Home

Age of children in the Home

Number of Parents in the Home

Is student a foster child?
Yes	No
Does student have a parent in prison?
Yes	No
Has student been detained in the Juvenile Justice system?
Yes	No
Is student a runaway, or homeless youth?
Yes	No
Is there currently one or more computers in the home?
Yes	No
Is there currently Internet connected in the home?
Yes	No
Has your student used a computer before?
Yes	No
What programs have they used?
Word	Powerpoint	Excel

	Once your Application has been submitted, a representative from CFC will contact you for some followup information. This information will be required for admission into the program - - Brief Essay (one page), written by student why he/she should be selected for the KidCo Program. - Copy of most current report card. - Copy of families previous years tax return cover page
	Computers For Children 2558 Delaware Ave. Buffalo, NY 14216 716.823.7248 716.823.0960 fax cfc@computersforchildren.com Hours of Operation: Office Hours 10-6pm Mon-Fri Store Hours 3-7pm Tues-Fri, Sat 11-4pm