TAG Reconnect Client Application Form
Please refer to the TAG Reconnect project for program details:
https://tagnw.org/reconnect

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.

Applicant Requirements:
* 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 director@tagnw.org or 360-312-7105 for any questions or comments.

NOTE: All fields are required.
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APPLICANT CONTACT INFORMATION
Name *
Phone Number *
Email Address *
REFERRER CONTACT INFORMATION
Agency Name *
Staff Name *
Staff Phone Number *
Staff Email Address *
APPLICANT QUESTIONS
What is the computer skills literacy of the applicant? *
How will participation in the TAG Reconnect program benefit the applicant? *
REFERRER CONFIRMATION
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. *
Required
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