ACP Tablet Application

ACP Tablet Application

Welcome! To apply for a tablet funded by the Affordable Connectivity Program (ACP) complete the application here. As long as you receive some type of Government Assistance you will qualify. Additional documentation is sometimes required.

Adult Information:
Full Name*
Email*
example@example.com
Phone Number: *
Last 4 of SSN:*
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

If the benefits are in the child's name fill out the information for them below.
Child's Full Name
Date of Birth for Child:

MonthDayYear
Date
Last 4 of Child's SSN:

Type of Assistance Received
(EBT/SNAP, WIC, MEDICAID, PUBLIC HOUSING, SCHOOL LUNCH, PELL GRANT, VA PENSION/SURVIVOR FUND)
ADDITIONAL DOCUMENTATION AND/OR AWARD LETTER MAY BE REQUIRED TO QUALIFY

Select data plan*

Basic- 15gb monthly (included with $11 activation fee)Advantage- 25 gb monthly ($12 additional)

If local pick up cannot be arranged there will be an $11 shipping charge. The tablet will be shipped priority and will arrive within 3-5 business days after payment is received.
Signature*

Clear
Should be Empty: