Chromebook Englishadmin2020-04-23T13:11:30-07:00 Please enable JavaScript in your browser to complete this form. - Step 1 of 4Name *FirstLastDate of Birth *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *EmailDo you have Internet at home? *YesNoWould you like someone to call you about low cost internet offers in your area?YesNoNextThe 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 REFRESHNO Software Warranty or Support is provided by Fresno State REFRESHNO Ongoing Service Agreement or Commitment is provided by Fresno State REFRESHFresno 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 EXCHANGESNote: 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). NextFresno 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: *InternetEmail/Video ConferencingSeek job/employmentWork/BusinessEducationSocial MediaNextI, 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 knowledgeI understand and agree to the new and/or refurbish computer system conditions as specified on pg 2 of the applicationI have attached all information requiredSubmission of this application form does not automatically entitle me or any family member, which I represent, new and/or refurbish computer equipmentI 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.EquipmentI am requestingd the following equipmentChromebookPLEASE SEND copy of identification, which states your name and address to 559-206-4618. (example: drivers license, proof of age, bill etc.) Signature *Clear SignatureNameSubmit