2025 Digital Equity Project Laptop Application

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THIS FORM IS FOR CASEWORKERS, SOCIAL WORKERS, AND DIRECT SERVICE PROVIDERS ONLY.
(This form is not for clients to fill out.)

Bookmark the web address for this application: https://www.danenet.org/2025-laptop-application/

DANEnet has received a generous grant through the Public Service Commission of Wisconsin to provide ongoing, one-on-one help for people in Dane County who need access to a personal laptop as well as free tech support, affordable internet, and digital skills training in order to thrive.

This form is for direct service providers at partner agencies to complete on behalf of any qualifying client needing a laptop, and by submitting this form you understand your client will need to complete a surveys about their laptop use in 3 & 6 months. If the recipient is approved for a laptop, a laptop will be provided within 2-3 weeks. If an application is rejected for any reason, we will contact you within 2 days to let you know.

If you have questions about this program, form, or our policies, or you want to buy her coffee, contact Shawn via shawn@danenet.org. Thank you for reading all this and sorry for the long form! Funders/partners sure ask for a lot of info. :)

Direct Service Provider Organization *

Laptop delivery preference: *

Ship to Recipient

Ship to Direct Service Provider Organization

This Recipient is receiving a laptop from our Bulk Inventory

Laptop Recipient First Name *

Laptop Recipient Last Name *

Recipient Phone Number *

Recipient Email (not required)

Recipient Street Address *

Recipient City/State/Zip *

CAM tag # of laptop (Required if from a Bulk Order)

Which of the following services would your client benefit from in addition to a free refurbished laptop and tech support for that laptop? (Check all that apply) *

Help Recipient sign up for discounted home internet

Remote Digital Literacy training opportunities

In-person Digital Literacy training opportunities

Spanish-language Digital Literacy instruction

None of the above

Required

Does anyone in the computer recipient's household identify with any of the following eligibility statements? (Internet speed test available online at https://www.speedtest.net/) *

Household income is at or below 200% of the Federal Poverty Guidelines

The need for internet access was made apparent by COVID-19

Household has slow internet (less than 100 Mbps download and 20Mbps upload)

No home internet due to cost, quality of service, policies, or practices of providers

Household unable to afford the basics on housing, childcare, food, transportation, healthcare, and technology

None of these apply

Required

Does anyone in Recipient's household identify with any of the following statements? Please check all that apply *

60+ years of age

Incarcerated Individuals

Veterans

Person with Disabilities

Rural

Racial or Ethnic Minority Group

<200% of the Federal Poverty Guideline

English Language Learners

None of these apply

Required

How many individuals live in Recipient household? *

Which of the following best describes Recipient? *

Gender of Recipient *

Recipient Age *

Caseworker name (first and last) *

Caseworker email *

Caseworker phone *

Caseworker Org Address (if we are shipping to Direct Service Provider Organization)

By submitting this application I confirm the above information to be true and I'm able to provide further documentation upon request. I have also explained to my client that in order to keep the laptop, they will be required to complete an email/online survey in three months and a brief phone interview regarding progress towards their online objectives in six months.* *

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