Receive Computer

This form will enable ACTLAP to determine your status as a potential Student and Participant and assist us in analyzing your Literacy needs. Any organization wishing to have their staff registered on ACTLAP Literacy Training must be correctly registered with the federal government.

Applications will be sent via email to ACTLAP.

Contact Information

First Name
Last Name
Phone Number
Fax Number
Email
Education Level
Mailing Address

Company Information

Company/ Organization Name
Company/ Organization Address
Is your company a charitable/non-profit organization?: No Yes

If yes, please provide charitable registration number

Note: ACTLAP can only provide computers to Registered Charities, or students that have enrolled and completed the ACTLAP Study Program

Student Information

Are you currently enrolled, or have you graduated from the ACLAP Study program?: No Yes
If yes, please enter dates

Do you have a computer or are you interested in our program to receive a computer after the Training Program Complete? Own Computer Interested in receiving computer

What would you use the computer for?
Do you have a preference for a particular computer?

Application will be sent via email to ACTLAP

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Receive Computer