Chromebook English

Name *

First

Last

Date of Birth *//

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Do you have Internet at home? *

Would you like someone to call you about low cost internet offers in your area?

The Office of Community and Economic Development at Fresno State via its initiative “Fresno State REFRESH” provides affordable & refurbish computer hardware to families living in the San Joaquin Valley, who do not currently own a computer, or for financial reasons are unable to afford computer equipment.

Applicants who have been chosen to receive an affordable new and/or refurbish computer must send valid government ID in order to have computer hardware sent. Each applicant must also agree to the Fresno State REFRESH computer hardware terms.

Computer systems are provided under the following conditions: Please Check that you fully understand conditions. *

NO Hardware Warranty or Support is provided by Fresno State REFRESH

NO Software Warranty or Support is provided by Fresno State REFRESH

NO Ongoing Service Agreement or Commitment is provided by Fresno State REFRESH

Fresno State REFRESH staff/volunteers can perform only very cursory checks as to the safety and reliability of the equipment provided.

Please Check that you fully understand conditions. *

Fresno State REFRESH staff/volunteers can perform only very cursory checks as to the safety and reliability of the equipment provided.

I understand that the equipment being shipped to me comes in its original package and I accept as is. No specific warranties are guaranteed by Fresno State REFRESH. All items are as is and final. NO RETURNS or EXCHANGES

Note: If refurbish laptop is provided, battery may or may not work. In such case a power cable will be needed to fully operate the computer.

Please Note:

This application form is used purely as a guide so Fresno State REFRESH can determine eligibility and/or any other requirements that applicant may need.

In accordance by Federal and State Privacy Laws, any information provided in this form will not be disclosed to any other organization(s).

Fresno State REFRESH has entered into an agreement with Microsoft to provide legal copies of Microsoft Windows Operating systems with refurbished computers. The agreement has very specific requirements on what types of individuals are eligible to receive Microsoft Software with refurbished PCs. Please indicate the primary use(s) of this refurbish computer/software.

Please mark all that apply: *

Internet
Email/Video Conferencing
Seek job/employment
Work/Business
Education
Social Media

I, hereby certify that in applying for computer equipment from Fresno State REFRESH, I understand and agree to the following:

All questions have been answered truthfully to the best of my knowledge

I understand and agree to the new and/or refurbish computer system conditions as specified on pg 2 of the application

I have attached all information required

Submission of this application form does not automatically entitle me or any family member, which I represent, new and/or refurbish computer equipment

I do not intend to sell any new and/or refurbish computer equipment that may be provided to me by Fresno State REFRESH.

If approved, I understand that my equipment will be shipped via courier to the address provided.

Equipment

I am requestingd the following equipment

Chromebook

PLEASE SEND copy of identification, which states your name and address to 559-206-4618. (example: drivers license, proof of age, bill etc.)

Signature *