Grant Description

Before you start...

Applicant Contact Information

Applicant Name*
Mailing Address*
Is your mailing address a PO Box?*
Please enter a physical address. Your equipment cannot be shipped to a PO Box*

Technology Requests

You may request up to $1,000 worth of technology to enhance access to professional learning opportunities, training, meetings, and resources to support business growth and development.  Please check the items you would like to request. 

If you would like to request a laptop or tablet please choose which you would prefer. If you do not want to request a laptop or IPAD choose None.*
Please check any additional technology that would benefit your childcare program. You may request all 3 options.*
You may choose 1 additional tool to use for your childcare program.*
Are you interested in receiving training on how to utilize your device? *

Supporting Documents

1099 Acknowledgement*
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*Need a W-9 form? Go to www.crecnm.org & click “visit our news page"
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E-Signature

By signing below, I certify the information I provided on this form and with this form is true and correct to the best of my knowledge.

 

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Date*
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