TAG Reconnect Client Application Form
Please refer to the TAG Reconnect project for program details:
We request that applications are completed by a social service agency staff member (Referrer) for their client (Applicant). Please review the form and determine all necessary information before beginning the application.
* Be a client of a social service provider partner.
* Have identification.
* Have at least "beginner" computer skills.
Internet access is not required, but is highly recommended.
Please contact Michael Gan, TAGNW Executive Director, at
or 360-312-7105 for any questions or comments.
NOTE: All fields are required.
Sign in to Google
to save your progress.
APPLICANT CONTACT INFORMATION
REFERRER CONTACT INFORMATION
Staff Phone Number
Staff Email Address
What is the computer skills literacy of the applicant?
How will participation in the TAG Reconnect program benefit the applicant?
I confirm that applicant is a client of the referring agency, has identification, and has at least beginner computing skills to be an eligible participant in the TAG Reconnect program.
Never submit passwords through Google Forms.
This form was created inside of Technology Alliance Group NW.