Hardware Grant Application

To apply, fill out this form. Please do not email requests or send hard copies.

Organization name:*
Organization address, city, state & zip (if applicable):
What is the purpose of your organization? Please describe how your organization serves the community.*
Organization website:*
Does your organization have 501(c)3 status? If your organization is under the fiscal sponsorship of another organization, please provide their name and contact information here. (Note: We can still work with you if you do not have 501(c)3 status.)*
Primary contact name:*
Primary contact position:*
Primary contact email:*
Primary contact phone:*
Please list additional contacts, if applicable:
Is your organization within the Portland city limits?*
Yes No
If your organization is within the Portland city limits, can you answer yes to ALL of the questions on this page: City of Portland's non-discrimination and Equal Employment Opportunity policies?
Yes No
We do not package or ship items. Are you or another representative from your organization going to be able to come to our Portland location and pick up the granted items?
Yes No
What equipment do you need from Free Geek? Please specify amount and type, i.e. number of monitors, number of computers, etc., keeping in mind we may not be able to supply everything requested.*
What will it be used for? Be as specific as possible.*
When do you need it by? We cannot always meet deadlines but we will try. The more heads-up you give us, the better.*
Do you have a contact who is already volunteering or working at Free Geek?
Do you have a person in your organization who can be responsible for technical support issues?
Please explain your plan for environmentally responsible disposal of any hardware that eventually fails (returning the equipment to Free Geek is a great option!):
We request that all grant recipients to complete a short, three-month follow-up survey. Will you be willing to do this?*
If we accept your application, may we publish a brief blurb about this process on our webpage?

Please type the letters/numbers below into the box so we know you're human.