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Everything About Kiosks!
You can fill in the fields below with as much detailed information as possible and send it to our agents.

General Information
Full Name: *
E-mail: *
Confirm E-mail: *
Priority:
STAGE 1
1. About Your Organisation
Name of Host Organisation *
(The legal or trading name of your organisation)
Address *
Suburb *
State *
Postcode *
Applicant Phone Number *
Organisation Phone Number
Please provide your preferred time/s and day/s of the week when NEC can ring you to discuss your application
What are your centre's operating hours? *
(e.g. Mon-Fri 10:00 to 4:00 or each day's hours)
What activities does your organisation provide or run for Seniors (people over the age of 50)? *
e.g. Discussion groups, courses, club activities
Do you have an existing relationship with
Are you expecting to be permitted to occupy the current premises up to the end of June 2011? *
Can you provide insurance of the kiosk against fire and theft? *
(Up to $4,000 for kiosk equipment)
Do you have public liability insurance? *
How many years has your organisation been running?
How many members belong to your organisation?
Additional comments
Feel free to add additional comments/clarifications
How did you find out about the Broadband for Seniors project? *
2. About Your Site
Is the area supervised during opening hours? *
Is the area secured out of hours? *
Does the proposed Kiosk area have *
3. About Your People
Can you provide a Host Administrator? *
(someone with basic PC knowledge)
Host Administrator Name *
Host Administrator Phone *
Host Administrator Email Address
Can you provide volunteer tutors? *
(people who can teach/demonstrate PC basics, internet surfing using IE, sending email via Gmail and letter writing using WordPad)
Verify Submission
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