ConnectWell Internet Access Application

ConnectWell Internet Access Application

Affordable internet for homeschooling families & the communities that serve them.
Welcome! This application is for ConnectWell, an affordable internet access program powered by Love Well Spent.

Please take 5–7 minutes to complete this form. Your answers help us confirm your eligibility and match you with the best internet plan and device option.

You’ll need:
- Your name and contact info
- Your home address for shipping
- Info about your homeschool or organization
- Your device choice (or request for help choosing)
- Payment information (credit/debit card)
Before submitting, you’ll be asked to acknowledge our terms & conditions

If you need help at any point, email us at connectwell@lovewellspent.org
Contact Information
E-mail*
Name*
Phone Number*
Format: 000-000-0000.
State of Residence*
Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What best describes who is applying for ConnectWell service?*
Shipping Provider
Tracking Number

For Nonprofit & Community Organizations

If you are applying on behalf of a nonprofit, learning pod, or educational support organization, please complete the section below. All information is kept confidential and used only for ConnectWell eligibility review.
Organization Name
Type of Organization
Organization Website or Social Media Page
What is your organization's primary mission or focus?
Homeschooled studentsLow-income familiesStudents with special learning needsSingle Parent HouseholdsCommunityOther
Approximate number of users supported by this device
Upload proof of nonprofit or organizational status

(e.g., IRS determination letter, program flyer, fiscal sponsor agreement)
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Device Selection & Payment
Franklin T10 – $58Shield 5G Home Hotspot (Pre-Order) - $149JeXtream RG2100 – $183ATEL WB550 5G - $367 (for community organizations)Inseego Wavemaker FX3100 5G - $440 (for community organizations)I’m not sure help me choose
Yes, we are requesting a subsidized planNo, we will cover the full costWe are interested in sponsoring another family
How much can you contribute toward the cost of the device?
How much can you contribute monthly for the service plan?

Proof of Program Enrollment (for Subsidy Requests)
To qualify for discounted service, please confirm your participation in a federal or state assistance program.
(e.g., SNAP (Food Stamps), Medicaid, SSI, TANF, WIC, EBT, Section 8 Housing, LIHEAP, or any state-specific benefit program.)
Upload one of the following approved documents:

You only need one form of verification: - Letter of eligibility or benefits approval. - Screenshot or photo of program card (EBT, Medicaid, etc.) - Official correspondence dated within the past 6 months - Current pay stub showing eligibility (for income-based programs)
Drag and drop your file or click to upload icon

All documents are confidential and used only to determine eligibility for discounted pricing. They will not be shared or retained beyond what is required for verification.
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Terms & Conditions Acknowledgment
From Past ParticipantFacebook GroupOnline SearchI am a Digital Access Grant ParticipantVELA NetworkOther
Submit
Is there any additional information you would like to share or any questions you have regarding the Love Well Spent ConnectWell Internet Access Program? (Optional):
Please verify that you are human*
Signature*
Should be Empty:

Contact Information