Name
*
First Name
Last Name
Email
*
example@example.com
Date of Birth
*
 -
Month
 -
Day
Year
Date
What pronouns do you use?
Example: she/her, he/him, they/them, etc.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Sign up for SMS
By checking this box, you consent to receive SMS messages from Success Accelerator at the phone number provided. Message frequency may vary. Standard message and data rates may apply. Reply STOP to opt out at any time. Reply HELP for assistance. Your mobile information will not be sold or shared with third parties for promotional or marketing purposes.
Referred by (please include the organization name and name of the person):
Referral contact's email address
example@example.com
Which of the following do you identify with?
*
Involved with the Justice System (means a history with the criminal justice system and/or agencies such as John Howard or Elizabeth Fry)
Experienced homelessness
Experienced mental illness
Experienced trauma
Gender-based, intimate partner and family violence
Indigenous
In or are leaving the care of the Children's Aid Society
LGBTQIA2S+
Low Income OR on Social Assistance (Low income means an individual who earns less than $20,778 per year or $41,198 per year for a family of four, Social Assistance includes government income subsidy including EI, OW, ODSP, or Basic Needs Allowance)
Newcomer (means individuals who have resided in Canada for less than five years)
Person with a Disability (this includes any physical disability, mental impairment, developmental disability or learning disability)
Racialized (means groups of people who might experience unequal or different treatment on the basis of race, ethnicity, language, religion or culture)
Refugees
Single parent (yourself)
Substance abuse/addiction
Unemployed
None of the above
Other
What is your highest level of education?
*
Some High School
High School/GED
Some Post-Secondary
College
Bachelor's Degree
Graduate Degree
Other
How would you describe your current access to technology?
*
I don't have a computer at home
I share a computer at home
I have a computer but it is too slow/old to serve my needs
I have my own computer at home, good enough for my needs
I have a smart phone
I don't have a smart phone
Other
How would you describe your internet access?
*
I have hi-speed internet at home
I have dial-up or unreliable internet at home
I don't have internet at home
Other
What technology device are you interested in?
*
Computer Kit
Laptop
Desktop
Smartphone
Whatever device is available
If you are interested in a computer kit, please confirm which of the following you have:
*
A smart TV
A TV with input for HDMI or USB
A monitor screen
A tablet
An old computer that runs slow, so I need the software to make it run faster
I'm not interested in a computer kit
Other
If awarded, how would you be using this laptop? (select all that applies)
*
For work
For school (attending school, applying for school, completing assignments, etc.)
eLearning outside of school
Recreational (gaming, entertainment) to reduce stress and increase happiness
Internet Browsing
To be more efficient completing tasks (Paying bills, shopping, check weather, etc.)
To further my career (resume building, apply for jobs, interviews)
To stay connected with people
To create more financial stability (online job or building your own business)
Improve access to news, information, and resources
Other
Success Accelerator offers programs that elevates emotional intelligence, mental wellness, and offers other essential life skills. To learn more visit www.joinsa.ca/program. Would you be interested in attending these programs?
*
Yes
No
Other
Do you agree to share with us how you are benefitting from this laptop every three months for 1-year period?
*
Yes
No
Other
Would you be able to pick up the laptop on Saturday April 5, 2025 downtown Toronto?
*
Yes
No
Other
Tip #1
For the application, you'd want to tell us how being a computer recipient would make a greater net impact for YOU, not the importance of bridging the digital divide.
Tip #2
You'd want to avoid depending on AI for your written answer. Â We want to get a true picture of your story, voice, and goals. You'll have a much higher chance of being selected when the text is a reflection of who you are. Applications will not be evaluated on grammar or sentence structure, we are just looking for your story and your voice.Â
In your words, please share with us the reason you need this computer and how being a computer recipient would make a greater net impact for you (100-250 words).
*
Is there anything else you'd like us to know?
By continuing with this application, you agree to the following terms and conditions:
If you indicated that you are referred by an organization or someone, we may share the attendance of your participation in our program(s) with the organization or person as indicated.Yes, I'd like to stay in touch and get the latest updates by email.https://www.successaccelerator.ca/terms-and-conditionshttps://www.successaccelerator.ca/media-release
Signature
Please confirm
*
Yes, I have read and agree to the statement set out above and the Terms & Conditions.
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