Organisations application form

From ITShare SA Inc

Office use only
Application No	Entered into DB on date
Date of Application	Entered into DB by
Payment received	Invoice no

A processing and handling fee of $40 per computer must be paid before collecting the computer

Contents 1 Contact details 2 GENERAL INFORMATION 3 Existing Computer skills 4 Publicity 5 Feedback 6 Collection and training 7 ORGANISATION DETAILS

Contact details

Be sure to include at least one contact phone number.

CONTACT FIRST NAME	CONTACT LAST NAME
ADDRESS
SUBURB
STATE	POSTCODE
CONTACT NUMBER 1	CONTACT NUMBER 2

GENERAL INFORMATION

CATEGORY (please select one)

Non Government Organisation

Not-for-profit Organisation

Who referred you to ITShare SA?

.

Existing Computer skills

Please describe the computer skills of the person or people who will be using this computer. Please select one:

Basic

Intermediate

Advanced

What Operating System(s) are these person(s) most familiar with (if any)? Multiple selection(s) allowed:

Nothing

Windows

MacOS

Linux/Unix

Other (please specify)

Publicity

As part of our collaboration with Corporate Donors, ITShare & our donors may request interviews for media purposes. If you (or your organisation) would be willing to participate in any publicity events, please indicate.

YES

NO

Would you be willing to advertise the ITShareSA Technology Recycling Scheme in your (or your organisations) website, newsletter or other media?

YES

NO

Feedback

Are you able to provide feedback about the computer and the benefit it has provided once received from ITShare?

YES

NO

Collection and training

Will you be able to arrange collection of your computer at a training session?

YES

NO

If not, please provide a reason:

ITShare will provide an initial training session to members of your community organisation. Training of system users will be the responsibility of the individuals who have attended the initial training provided by ITShare. Are you willing to nominate a staff member / volunteer who will be responsible for the training of your service users? (maximum of two people, extra people will incur a fee of $15pp)

YES

NO

ORGANISATION DETAILS

a) What does your organisation do (Mission Statement etc)?

b) To whom does your organisation provide a service?

c) How many part time and full time staff are employed by your organisation?

d) How many volunteers participate in the activities of your organisation?

e) Do you have any existing computers, if so, how many and what are they used for?

SIGNATURE

NAME

ROLE IN ORGANISATION

DATE