TAGNW Reconnect Client Application Form
Please refer to the TAGNW Reconnect project for program details:
https://tagnw.org/reconnect

We request that applications are completed by a social service agency staff member (Referrer) for their client (Applicant). Please review the form and determine all necessary information before beginning the application.

Applicant Requirements:
* Be a client of a social service provider partner.
* Have identification.
* Have at least "beginner" computer skills.

Internet access is not required, but is highly recommended. PLEASE create an email address for the applicant if they do not already have one.

Please contact Michael Gan, TAGNW Executive Director, at director@tagnw.org or 360-312-7105 for any questions or comments.
Sign in to Google to save your progress. Learn more
APPLICANT CONTACT INFORMATION
Name *
Phone Number
Email Address
REFERRER CONTACT INFORMATION
Agency Name *
Staff Name *
Staff Phone Number *
Staff Email Address *
APPLICANT QUESTIONS
What is the computer skills literacy of the applicant? *
How will participation in the TAG Reconnect program benefit the applicant? *
REFERRER CONFIRMATION
I confirm that applicant is a client of the referring agency, has identification, and has at least beginner computing skills to be an eligible participant in the TAGNW Reconnect program. *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Technology Alliance Group NW. Report Abuse
Google Forms