Computers with Cause application Question Title * 1. How can we contact you? Full name Street address Zip code Phone number OK Question Title * 2. Primary reason for your need (check all that apply) Apply for work Learn technology Virtual/telecommute/work at home for a job Education Entrepreneur OK Question Title * 3. Determine debt to income ratio(Expenses are but not limited toMortgage, rentProperty taxes Strata fee / condo feeHouse / tenant insuranceUtility bills (cable, cell, electricity, water, etc.)Lease / car loan paymentVehicle insurance Life / Disability / Extended health (or other) insuranceBank feesDebt payments/debt repayment plan/student loansHouse insurance Vehicle insurance Clothing & shoes Health expensesVehicle maintenanceGroceriesPersonal care items (drugstore)Fuel / public transportation costsParkingClothing & shoesDaycareWork lunches & snacksBabysittingHair care) What is your total expenses per month What is your total income after taxes per month OK Question Title * 4. Can you supply copies of your income & expenses Yes No OK Question Title * 5. Has this experience impacted your household budget in any of the following (check all that apply) Reduced earning potential Residual debt Difficulty obtaining credit Degree in a field where employment cannot be acquired OK Question Title * 6. How many people are in your household OK Question Title * 7. Has anyone in your household ever been charged, or convicted of a crime Yes No OK Question Title * 8. Gender Female Male Trans (He, Him, his) Trans (She, her, hers) OK Question Title * 9. Race White or European Hispanic or Latino Black or African American Native American or American Indian Asian/Indian/ Pacific Islander Native American Multicultural OK Question Title * 10. Highest level of education No schooling completed Nursery school to 8th grade Some high school, no diploma High school graduate, diploma or the equivalent (for example: GED) Some college credit, no degree Trade/technical/vocational training Associate degree Bachelor’s degree Master’s degree Professional degree Doctorate degree OK DONE