Please fill out as much information as possible. All fields are mandatory unless marked by an asterisk(*). Please enter 'N/A' if not applicable . If you would prefer to mail or fax in your application, please print out the application, and send it here
	Name of School/School Board
	Address
	City
	Province
	Postal Code
	Phone #
	Fax#
	Name of Person Completing Application Email Address:
	Position

Please Note: (a) That the computer hardware made available under this project will be equipped with an operating system. (b) While the federal government undertakes to provide a functioning computer, any subsequent liabilities or repairs are the sole responsibility of the recipient. 1. What is the student population of your school/school board? Elementary:   OR   Secondary: 2. How many microcomputers are available to the students in your schools? Elementary:   OR   Secondary: 3. Are the computers concentrated in any particular area of study? If so, please list the area(s).* 4. Are your schools linked to any electronic learning network? If so, please list the network(s).* 5. To what extent will the requested computers be used for teaching purposes? 0% 25% 50% 75% 100% 6. Please tell us why you need the requested computers, how many you are requesting, and how you intend to use them. Name of the Director of Education: Date: Name of School Board Computer Coordinator/Contact (Instructional): Telephone: Fax: If mailing or faxing your application - Please return completed form to: Mr. Lucien Villeneuve Provincial Coordinator Alberta Computers for Schools Association c/o Alberta Learning Resources Centre 12360  142 Street Edmonton, Alberta T5L 4X9 Tel : (780) 427-9002 Fax : (780) 427-6683