DVD Request

1. DVD Request

Thanks for your interest in the Project ACT Training DVD.

The DVD contains 20 lessons on using the computer. If you need additional assistance, please contact the numbers provided on the DVD. A brief consumer satisfaction survey and a self-address stamped envelope is included. Please complete this and return it to Project ACT to help us continue with grant fund.

We are only able to provide the DVD to individuals in Alabama due to grant funding.

1. Please choose all that apply.

Please choose all that apply. Individual with Disability

Work with Individuals with Disabilities

Other (please specify)

*
2. Where should we mail the DVD to?

Where should we mail the DVD to? Name:
Mailing Address:
Apt/Suite #:
City/Town:
State:
ZIP:
Email Address:
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DVD Request

1. DVD Request

1. Please choose all that apply.

*2. Where should we mail the DVD to?

*
2. Where should we mail the DVD to?