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Community Tech NY Partner Intake Form
This survey will help us determine the potential partnership and project scope in order to build a mesh network with your community. Please fill out the form in as much detail as you can. Once you submit, you can schedule a follow-up conversation. More information about CTNY: https://www.communitytechny.org/
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* Indicates required question
Name
*
Your answer
Organization (if applicable)
Your answer
Email Address
*
Your answer
Website
Your answer
Location/Area/Region/ZIP Code for network
*
Your answer
Google Maps Link
Optional - please share a Google Maps URL for your location (pinned) or area
Your answer
How did you hear about CTNY?
*
Your answer
Purpose(s) of the mesh network
*
What are the reasons you want to setup a WiFi network in your area? Please be as expansive as possible.
Your answer
Priority
*
Please rate how important or essential you think this project is for the community.
Very high
1
2
3
4
5
Very low
Number of network/WiFi users
*
How many people do you estimate would access the mesh network?
Your answer
Size of the network coverage area
*
What do you estimate to be the range of the wireless network in distance? Consider mileage or city blocks or use an analogy like a football field to describe the size.
Your answer
When do you want to start the project?
*
MM
/
DD
/
YYYY
When do you need the network to be available for access?
*
MM
/
DD
/
YYYY
Notes about the project timeline
Your answer
What is your project budget?
*
Your answer
Funding Sources
*
Who (or what) is funding this project and network?
Your answer
Power Source(s)
*
How would the mesh network be powered? Choose all or any options.
Power/Utility Grid
Solar
Water Well
Generator
Battery
Other:
Required
Current Access to Internet
*
How do you currently connect to the Internet? This can include subscription cable or fiber connections, mobile data plans, public Wi-Fi, etc.
Your answer
Backhaul and ISP Providers in your area
*
Where would the high-speed internet signal come from that would connect to the mesh network? What are the Internet Service Providers (i.e. Verizon, AT&T, independent) that you might connect to?
Your answer
Questions?
Your answer
Any other details or comments you would like to provide?
Your answer
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