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Computers 4 Kidz
Refer a Child in Need

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To refer a child in need of a computer, please complete the FIRST form.
 
To Refer a Child Care center or other facility, Please scroll down and use the SECOND form. 
 
Include your telephone number and email address.  Be sure to click the "Send" button when you are finished.  Someone will contact you shortly. Thank You



Child's name

Child's age

Name of Parent or Guardian

Address 1

City, State

Zip code

phone number

Email address (required)

How did you hear about us?

Comments



Name of Facility

Number of Children Served by this facility

Age group of children served

Name of Contact Person

Address 1

City, State

Zip code

phone number

Email address (required)

How did you hear about us?

Comments