Would you or someone you know like to be considered as a recipient?

Please Complete the following APPLICATION form

Name

Nombre

First Name

Last Name

Email

Are you a student? Or submitting on behalf of a student?

¿Eres un estudiante? ¿O completando esta forma para un estudiante?

Yes

No

Phone

Teléfono

(###)

###

####

Today's Date

Fetcha de Hoy

MM

DD

YYYY

Type of Device

Tipo de tecnología

Statement of Purpose

Please include a short paragraph describing why you'd like to be considered as a recipient and how your chosen device would help you achieve your goals. Incluya un breve párrafo que describa por qué le gustaría ser considerado como un recipiente y cómo la tecnología elegido le ayudaría a alcanzar sus objetivos.

*Please note by submitting this application you are certifying that all information is true, complete, and correct. Completion of the iDream recipient application does not guarantee a device. Distribution is based on the number of available devices. All distributions and trainings occur in Davis, California. All applications are considered fairly and equitably by our board.