Applicant Organization (required)

Legal organization if different from above

My Organization is an: (required)
Arizona Public SchoolNonprofit Charter SchoolOther 501c3 NonprofitOther

Website

EIN (required)

ACC File Number (required)

ACC File Listing Link

Primary Contact Full Name (required)

Primary Contact Role (Required)

Primary Contact Email (required)

Primary Contact Phone (required)

Secondary Contact if different than Primary
PrincipalExecutive Director

Secondary Contact Name (required)

Secondary Contact Email (required)

Secondary Contact Phone (required)

These computers will be used for the following: (required)
STEM EducationAdministrativeClassroom LabOther

Number of Laptops Requested

Number of Desktops Requested

List other items requested, including quantity

Has your organization previously received tech equipment from AZ StRUT?
yesno

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