Just Plain Folks Organization, Inc.

INDIVIDUAL APPLICATION 

(For a single computer system only) 

             Thank you for your interest in applying for a free computer from Just Plain Folks Organization, Inc. (JPFO).  You must complete this application to be considered.  Every application is reviewed by the Board of Directors, but please be aware that we receive hundreds of applications each month and, while we understand that you may have questions about the process, we cannot follow up with every application.

            Please know that anything you send to us will not be returned  and becomes the property of JPFO.  Please do not send original paperwork, copies are sufficient.  If you are nominating a person you know, please include their information throughout the application. There will be a separate spot on the application for your contact information.  Please include the information that you do have and so we can contact them.

 Thank You and Good Luck!

Individual Information

Today's Date: _______________

Name of Individual: __________________________________________________

Home Address: ______________________________________________________

City: ________________________ State:___________ Zip: __________________

County: ______________________

Mailing Address (if different): __________________________________________

City: ________________________ State:___________ Zip: __________________

Home Phone: (______) _________________

Work Phone: (______) _________________

Cell Phone:  (______) __________________

E-Mail: ______________________________

Fax: (______) _________________________

Marital Status: (S)ingle, (M)arried, (D)ivorced, (W)idowed

If married, how long? _________________________________________________

Is there documentation enclosed in this application? Yes/No

If you are nominating a individual other than yourself, Please include your information:

Name of Individual: __________________________________________________

Home Address: ______________________________________________________

City: ________________________ State:___________ Zip: __________________

County: ______________________

Mailing Address (if different): __________________________________________

City: ________________________ State:___________ Zip: __________________

Home Phone: (______) _________________

Work Phone: (______) _________________

Cell Phone:  (______) __________________

E-Mail: ______________________________

The conditions below are only for our records to legally be able to give you a computer system as set down by our organization.

1. D.A.V.  candidates:  Show proof of your status when you apply for a computer. 

1. All other candidates:  We will need a letter from your doctor stating your illness on his or her letterhead stationery or from the hospital in which you are currently being treated.

1. Dialysis Patients:  A letter from your kidney doctor or a letter from your Dialysis Center on their letterhead stationery is acceptable.

All materials you send (including videotape and photos) will be retained by Just Plain Folks Organization and become the property of Just Plain Folks Organization.  Any expense you incur during the application process including postage, shipping, materials preparation (copies, photos, etc.) are your sole responsibility.  Just Plain Folks Organization, Inc. will not reimburse you for these expenses. Only one entry per person is allowed. All decisions of Just Plain Folks Organization, Inc. are final and absolute and not subject to inquiry.

Unfortunately, we will not be able to verify that we have received your application. Just Plain Folks is not responsible for lost applications. You will be notified if and when your application is approved.