Donating Tech: TeleHealth for Seniors (telehealthforseniors.org)
Please provide any camera-enabled smart devices you have at home. Old chargers are also incredibly helpful. If you wipe / reset your device to factory settings, all of your information will be deleted and it will be safe for others to use. By providing seniors and low-income (who are often on subsidized health insurance) with video-enabled devices, they will be able to take advantage of free wifi hotspots with Spectrum, or use the wifi outside of doctors' offices to conduct their doctors' appointments. We can provide seniors with guidance on how to set up an email and account for telehealth!

Important: All devices must have a FRONT CAMERA. We only accept functional smart devices. We cannot accept flip phones or devices that do not work.

Before you turn in your device, you MUST erase all data. For iPhones/iPads please ensure that you disable Activation Lock and Find My iPhone. For Samsungs/Androids.

ALL DEVICES MUST BE CHARGED, RESET, AND WIPED DOWN ACCORDING TO CDC PROTOCOL. Please see our guide for tips on resetting your device from our website here: https://drive.google.com/file/d/1Td-nMAIcdwsPV1rjUlcN-KAUNLrEy2jg/view

(TeleHealth Access for Seniors is a 501(c)(3) nonprofit. Your donations may be tax-deductible).

View Website: telehealthforseniors.org
First Name *
Last Name *
Email *
Phone Number *
Which devices can you give? *
Required
How many of the selected devices can you give? *
Do you have accompanying chargers you can give as well? (We accept cords and blocks.) *
Required
Is the device fully functional? As in, does it turn on and work? We only accept fully functional devices. *
Please check which requirements you can meet. We can only accept devices that meet all three. *
Required
Please select which region you are located in / closest to. Our volunteers and medical providers are located in these regions. If you are not in any of these regions, please click other. *
Can you ship your devices to us? We will email you with more information on where to send your devices. *
IF you cannot ship within your state: what is your address? We will do our best to have a volunteer in your area contact you and pick up these devices from a safe distance.
How did you hear about us? Please mention if a specific volunteer in your area directed you to our form in the "Other" category.
Would you like an official donation receipt for your tax records? Official donation receipts will be emailed to the email indicated on this form within 30 days of receiving the device and confirming it is functional. *
Required
Submit
Never submit passwords through Google Forms.
This form was created inside of Yale University. Report Abuse