Hot Spot Application

Hot Spot Application
Applications will be voided if the applicant is missing any of the following:

- Valid and current ID

- Proof of low income

- No to limited Internet access
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please upload your ID here. *

Selfies, regular photos, etc. will not be accepted as a legal form of identification. ID must be government issued.
Cancelof

Need for Hotspot

Section 4
Why do you need a hotspot? (Check all that apply)*

Remote workOnline educationJob searchingTelehealth appointmentsOther
Do you have any other means of accessing the internet? (e.g., public Wi-Fi, friends’ or relatives’ connections)*

YesNo
If you have other means of accessing the internet, please describe them:*
How many hours per day do you anticipate using the hotspot?*

Agreement and Signature

Section 7
I agree to use the hotspot for lawful purposes only and understand that misuse may result in termination of service.*

AgreeDisagree
Signature

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Date*

MonthDayYear
Date
Should be Empty:

Household Information