Broadband Survey

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Broadband Survey

First name *

Last name *

Phone number *

Email Address *

House Number *

Street address *

City *

State *

Zip code *

Community/Village *

Larson Bay

Manokotak

Portage Creek

Tununak

Hamilton

Emmonak

Afognak

Mentasta

Unalakleet

Brevig Mission

Belkofski

Chevak

Paimiut

Noorvik

How many people reside at the address where Starlink service will be installed *

Are you currently a Starlink customer?

Yes

What service do you need?

Option 1-Residential Starlink device, installation device set-up and service (*free service up to a year+)

Option 2-The Starlink-mini device including set-up and service for up to a year (portable Starlink, great for travelling to fish camp or hunting)

Option 3-Service subsidy to cover existing broadband service if qualified members do not want either Starlink device and already receive broadband from elsewhere (including if already set up with Starlink, GCI, ACS, Copper Valley, etc).

Option 4-Business/Enterprise

Installation Location & Mount Style

Wall Mount (Recommended)

Pole Mount

Roof Mount

Not Aplicable

Do you have latitude/longitude coordinates? If yes, provide coordinates.

Access Constraints or Special Instructions

Do you have a compatible device for setup?

iPhone 6s or newer with iOS 15.1+

Google Pixel 10 or newer

Android device with Android 8.0+

I don't have a compatible device

Special Requests or Comments

I understand that this service is part of a 12-month program and consent to the terms described above *

Yes

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