Request a Laptop

First Name*

First name of Parent/Guardian
Last Name*

Last name of Parent/Guardian
Name of Student*

First, Last name
What is the age of the student?*
What is the level of education of the student?*
- Primary
- Secondary
- High
Name of School*
Where is the student's location?*
Which country is the student in?*

Please type the name of the country in the box above
Email address to contact you*
Please provide a phone number to contact you*
Please include area code (Exa. 876-123-2233)
Why should you or the child be considered for a free Laptop?*
Provide us with an explanation of the situation and why you would like a laptop.

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