Your name (person's name, not an organizational name):

Your email:

Street Address:

Phone Number:

Your role in the organization:

Secondary contact person:

Secondary contact's email:

What documentation of ours have you read?

In what ways have you found our documentation to be lacking? What questions do you have that are not answered?

In your own words, describe what Free Geek is. (Do not copy text from our web site.)

What geographic area do you intend to serve? (Please be detailed and specific.)

Short, convenient name that describes your geographic area:

Have you read and do you agree to abide by the Free Geek Principles?
 Yes No

In what ways will these principles be difficult for you to follow?

What is your mission statement?

Does your mission statement have any conflicts with the original Free Geek Mission Statement ("To recycle used technology to provide computers, education, internet access and job skills training to those in need in exchange for community service.")? If so, please explain.

Explain how your group will make decisions. How will you deal with contention? How will those decisions be recorded?

Why have you sought to be a non-profit organization? What communities will you be serving? How will your work benefit them?"

Why have you chosen the Free Geek model? What about it makes it right for your situation and goals?

Briefly, what is your business plan? What are your next most immediate steps toward establishing yourself?

How many people are already interested in your group? Which other organizations, especially local ones, have you made connections with?

What kinds of skills do your volunteers have?

What kinds of skills do you need to recruit for?

Do you know how to contact other Free Geeks by phone?
 Yes No

...by email?
 Yes No

...by the Startup list?
 Yes No

...by IRC?
 Yes No

What email addresses did you sign up to the startup list with?

Have you been in contact with a member of any Free Geek yet? Who was it, which Free Geek are they affiliated with, how did you contact them, and what did you discuss?

Please give us any feedback on this form:

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