STUDENT TECH ACCESS PROGRAM (STAP) APPLICATION FORM

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SECTION 1: BASIC INFORMATION

First Name *

Last Name *

Date of Birth *

Email Address *

Confirm Email Address *

Phone Number *

SECTION 2: ADDRESS DETAILS

Street Address *

City *

State *

ZIP code *

STUDENT STATUS

Are you currently a student? *

If yes, select one:High SchoolCollege / UniversityTrade School / Certification Program

School / Institution Name *

Upload Proof of Enrollment or Acceptance *

SECTION 4: ELIGIBILITY VERIFICATION

Do you receive any of the following? (Optional)Pell GrantSNAP BenefitsFinancial AidNone

Do you have a Valid ID (Driver’s License, State ID, or Passport) *YesNo

SECTION 5: DEVICE SELECTION

Select your preferred laptop brand: *

Preferred Laptop Type: *Basic (Web browsing, schoolwork)Mid-range (multitasking, light design)High-performance (coding, editing, gaming)

Select your preferred smartphone brand: *

Preferred Phone Type: *StandardPremium

SECTION 6: AGREEMENTS

1. Data Collection *

I grant STAP permission to process my personal information solely for eligibility assessment and device coordination.

2. Verification *

I authorize STAP to verify my enrollment status and identification with the respective issuing institutions.

3. Accuracy *

I certify that all information provided is true. False information will lead to immediate disqualification.

4. Privacy *

Data is stored securely and will never be sold to third parties.

5. Consent *

I consent to be contacted via email or phone regarding my application status.

6. Certify *

I certify that all documents and information provided are 100% accurate.

SECTION 7: FINAL STEP

Why do you need this device? (Optional but powerful for approval)

Why Choose STAP?

Fast Approvals

No Upfront Costs

Student Support

Trusted Program

Don’t Fall Behind — Get Connected Today

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