LEAP Program - Individual/Family Technology Discount

LEAP Individual/Family Application Process

Application Method: Online form (with option to email if form submission issues occur)

Required Information:
1. Date of application
2. Referring organization (if applicable)
3. Contact person for referring organization (name, email)
4. Applicant's personal information:
- First and last name
- Home address
- Apartment complex (if applicable)
- County (e.g., Kent, Ottawa)
- Email address
- Phone number
- Date of birth (M/D/Y)
5. Household composition (list other household members with ages and schools attended)
6. Refugee status:
- Current or former refugee?
- Country of origin
7. Education/Employment:
- Student status or job/career training involvement
- GED, ESL, or ESOL enrollment (if applicable, include school/organization)
8. Annual household income range
9. Current benefits/assistance programs participated in:
- Unemployment or Workman's Comp
- Social Security Disability Insurance (SSDI)
- Michigan BRIDGE Card (Food Assistance)
- Michigan BRIDGE Card (Cash Assistance)
- Michigan WIC Program
- Medicare
- Medicaid
- Section 8/HUD subsidized housing
- Free or reduced school lunch programs
- MDHHS Child Care Assistance
10. Technology access assessment:
- Does applicant's household currently own a computer? (Yes/No)
- Home internet access status and provider
11. Need statement: Why the applicant/family needs a computer
12. Additional information (optional)

Submission: