💻 Computer Donation Application (2025)

Name*

First NameLast Name
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
What pronouns do you use?
Example: she/her, he/him, they/them, etc.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
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 homelessnessExperienced mental illnessExperienced traumaGender-based, intimate partner and family violenceIndigenousIn or are leaving the care of the Children's Aid SocietyLGBTQIA2S+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)RefugeesSingle parent (yourself)Substance abuse/addictionUnemployedNone of the aboveOther
What is your highest level of education?*

Some High SchoolHigh School/GEDSome Post-SecondaryCollegeBachelor's DegreeGraduate DegreeOther
How would you describe your current access to technology?*

I don't have a computer at homeI share a computer at homeI have a computer but it is too slow/old to serve my needsI have my own computer at home, good enough for my needsI have a smart phoneI don't have a smart phoneOther
How would you describe your internet access?*

I have hi-speed internet at homeI have dial-up or unreliable internet at homeI don't have internet at homeOther
What technology device are you interested in?*

Computer KitLaptopDesktopSmartphoneWhatever device is available
If you are interested in a computer kit, please confirm which of the following you have:*

A smart TVA TV with input for HDMI or USBA monitor screenA tabletAn old computer that runs slow, so I need the software to make it run fasterI'm not interested in a computer kitOther
If awarded, how would you be using this laptop? (select all that applies)*

For workFor school (attending school, applying for school, completing assignments, etc.)eLearning outside of schoolRecreational (gaming, entertainment) to reduce stress and increase happinessInternet BrowsingTo 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 peopleTo create more financial stability (online job or building your own business)Improve access to news, information, and resourcesOther
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?*

YesNoOther
Do you agree to share with us how you are benefitting from this laptop every three months for 1-year period?*

YesNoOther
Would you be able to pick up the laptop on Saturday April 5, 2025 downtown Toronto?*

YesNoOther
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. 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.
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

Clear
Please confirm*

Yes, I have read and agree to the statement set out above and the Terms & Conditions.
Should be Empty:

Tip #1

Tip #2

By continuing with this application, you agree to the following terms and conditions: