Reutilized Computer Request Survey

UCP's Waste Not Program is funded through STAR, Alabama's Assistive Technology Resource.

This program accepts donations of durable medical equipment and computers to help individuals with disabilities obtain these reutilized items at no cost.

Reutilized computers are limited:
*Large number of requests for computers per month
*Wait list of several months
*Donated computers must meet minimum standards to be accepted

1. To be placed on the waiting list for a computer, please enter the following information.

To be placed on the waiting list for a computer, please enter the following information. Name:
Address:
Address 2:
City/Town:
State:
ZIP/Postal Code:
Email Address:
Phone Number:

2. Each reutilized computer will have at least Windows XP, monitor, keyboard, mouse, and internet ready hardware.

Please list any special requests needed due to your disability. Waste Not can not guarantee the ability to meet any special requests. (Ex: Laptop, Large Monitor, etc.)

Each reutilized computer will have at least Windows XP, monitor, keyboard, mouse, and internet ready hardware. Please list any special requests needed due to your disability. Waste Not can not guarantee the ability to meet any special requests. (Ex: Laptop, Large Monitor, etc.)

*
3. In order to be placed on the waiting list for a computer, you must read and agree to each of the following conditions.

	I agree	I disagree
All equipment is "as is" condition.	*In order to be placed on the waiting list for a computer, you must read and agree to each of the following conditions. All equipment is "as is" condition. I agree	All equipment is "as is" condition. I disagree
It is my responsibility to make arrangements for the computer to be picked up in a timely manner.	It is my responsibility to make arrangements for the computer to be picked up in a timely manner. I agree	It is my responsibility to make arrangements for the computer to be picked up in a timely manner. I disagree
Once a request has been met, I can not request another computer for 12 months.	Once a request has been met, I can not request another computer for 12 months. I agree	Once a request has been met, I can not request another computer for 12 months. I disagree
No funding is available for anything I may need to buy for the computer (ex: internet services, CDs, antivirus, software, etc.).	No funding is available for anything I may need to buy for the computer (ex: internet services, CDs, antivirus, software, etc.). I agree	No funding is available for anything I may need to buy for the computer (ex: internet services, CDs, antivirus, software, etc.). I disagree
Waste Not, STAR, or UCP are not responsible for maintaining, repairing, or replacing any part of the computer.	Waste Not, STAR, or UCP are not responsible for maintaining, repairing, or replacing any part of the computer. I agree	Waste Not, STAR, or UCP are not responsible for maintaining, repairing, or replacing any part of the computer. I disagree

Reutilized Computer Request

1. Computer Request

1. To be placed on the waiting list for a computer, please enter the following information.

2. Each reutilized computer will have at least Windows XP, monitor, keyboard, mouse, and internet ready hardware.Please list any special requests needed due to your disability. Waste Not can not guarantee the ability to meet any special requests. (Ex: Laptop, Large Monitor, etc.)

*3. In order to be placed on the waiting list for a computer, you must read and agree to each of the following conditions.

2. Each reutilized computer will have at least Windows XP, monitor, keyboard, mouse, and internet ready hardware.

Please list any special requests needed due to your disability. Waste Not can not guarantee the ability to meet any special requests. (Ex: Laptop, Large Monitor, etc.)

*
3. In order to be placed on the waiting list for a computer, you must read and agree to each of the following conditions.