US Technology Fund Application
 Application must be complete to be eligible for a US Technology Fund award.

Organization: ________________________________ Number of years organization has been in existence: ___

Address: __________________________________ City: ________ ______________ State: ___ Zip: ______

Primary purpose of the organization: __________________________________________________________

__________________________________________________________ _________ ___________________
                                       
 Please attach a copy of:
  • Brochure or other descriptive information.
  • Documentation of your nonprofit 501(c)(3) status
  • IRS 990
  • Annual Budget
  • List of Board Members (name, business name, address, phone number, e-mail address)
Value of computer services requested ($1,000 maximum)? $________ . ____

How would these computer services benefit your organization/association? ____________________________

______________________________________________________________________  ________________

_______________________________________________________________________  _______________

Do you currently have a contract with a computer support organization? _________  (yes / no)
                                       
Certification: I certify that the information contained in this application is true and correct to the best of my knowledge,
and that I have the authority to request funds for the organization named above.

Name: _________________________________________________________

Signature _______________________________________   Date: _________

Title/position within organization ____________________________________
                                       
Return materials to:
US Technology Fund c/o Bytes Bits & Megabytes
214 Live Oaks Boulevard
Casselberry, FL 32707
                                       
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