Computer Request Form
Rising Hope refurbishes donated desktop computers to distribute to members of the Route One Corridor community in need. Please fill out this form to be added to the list and you will be contacted when a computer is available.

Requirements:
* Proof of school enrollment or employment needs.
* Proof of residence in Route One Corridor community.
* Access to an ethernet port (on a router or wall) for internet connections.
* Ability to pick up computer when it is ready during Rising Hope's open business hours 10am-4pm Tues-Fri
Email address *
Full Name *
Your answer
Address *
Your answer
Phone number
Your answer
Please provide a description of why you need a computer. If school, please include the name of your school and program of study. If employment, please provide employer name and job title. *
Your answer
Additional Needs (please note computer requests with additional needs selected will take longer to fulfill)
Comments
Your answer
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