Device Request Form
Thank you so much for participating in CETI's device access project.  For more information and details contact us at or find us at

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Name *
Email Address *
Phone number *
Organisation/Profession (optional, if relevant to your request)
What devices do you need (smartphones/tablets/laptops, how many) *
Would any peripheral devices (webcams, mice, keyboards, monitors, network routers, headphones...) be helpful?  if so, what devices, and how many.
What are the likely uses for these devices (education, telehealth, applying for work, accessing internet, ...) *
Who is it for (types of audience - students, educators, people with health needs, neighbourhood, ...) *
Likely zipcode of use *
By participating in this project, I agree to CETI's Code of Conduct, the Contract/Agreement, and the Liability Agreement (docs on website). *
Thank you so much for your participation.  Please add any comments, questions, suggestions here.  And please share information about the project with your network esp. if there are others who might need devices.
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