Labdoo Laptop Request Form

Rev.  001

Requester Information:
======================
Your Name: Dorothy Mbambu
Your Email Address: kiyosima2009@gmail.com
Your Organization : Kasese Young Single Mothers Association (KIYOSIMA)
Organization Website: N/A
You Labdoo account user name: (this is needed so that Labdoo can assign laptops to your project--registration can be done here: https://www.labdoo.org/user/register)
Project title: (a short title for your project)
KIYOSIMA TEEN MOTHERS’ SKILLS CENTER


Project Site: 
=============
    1. Project Summary: (Please provide a brief statement about the purpose that the laptops will serve in your project site.)

We are a Uganda Community Based foundation that advocates for skilling the vulnerable teen mothers from poor families in Kasese district, western Uganda. The purpose of the foundation is to promote, plan and provide employable skills for the the teen mothers out of the regular school program. 
 
The development of our KIYOSIMA skill development center creates a learning environment that, among other things, should enable teen mothers and other children to use digital technologies. We plan to keep in touch with the learners through a computer with an internet connection. We are currently designing internet lessons and our learners are passionate about this. One of the aims of our work is to enable the learners to use computers, so we plan to always have laptops in the center that the learners can work with.

2.  Project Location: Kidodo Cell, Railway Ward, Kasese Municipality, Uganda Western
3.  Preferred language(s):English
4.  On Site Contact Information (please provide at least one way to contact):
    4.1. Name: Baluku Henry
    4.2. Phone:+256 789 283450
    4.3. Email: henrybaluku@gmail.com
    4.4. Physical address (street, city, zip code, country...):
Mutanywana Rd, Adjacent to Low Price Gardens, Fair Earth Library, Kidodo Cell, Railway Ward, Kasese Municipality, Kasese District, Western Uganda.
    4.5. GPS coordinates (if you know them or if you can find them out):
5.  Claimed IT equipement
    Number of Laptops needed: 10
    Number of eBook Reader needed: 03 
    Others needed (Tablet-PCs etc): 03 
6.  Number of students: 35
7.  Number of teachers: 02
8.  Electricity in the room: (Voltage and plug/socket type, e.g. type A, B, C, D, etc. see following link for explanation of types: http://en.wikipedia.org/wiki/AC_power_plugs_and_sockets)
 Type G. 240V supply voltage and 50Hz
9.  Does the room have access to the Internet? [yes / no]
	Yes 
    9.1. Is the access via wireless or cable?
	Access to wireless
10. Conditions about the room where the laptops will be installed:
    10.1. Is the room secure? [yes / no + brief explanation]
	Our room is made of iron roof, metallic doors, cement screed and ceiling.
    10.2. Can the room be locked in a way that the supervisors (e.g. teachers) can control access? [yes / no + brief explanation]
	The room can be locked and keys kept under supervision of the instructor. Access to the room is within the permission of the instructors. 
    10.3. Is the room weather-proof? (e.g. does the room protect the laptops from rain, sand, etc?) [yes / no + brief explanation]
Yes. The room is made up of an iron roof, cement plaster wall, cement screed floor and ceiling that is adequate to protect laptops from weather.

11. How did you hear about Labdoo?:
--Search Engine (e.g. Google)
--At local Conference,
--At online Conference,
--From other organizations/companies,
--Facebook
--Instagram
--Other (please describe)
We searched via Google search engine to come across Labdoo web site. Its on this ground that we took a step to make our application. 

12. Picture(s) of the school, students, teacher, etc with this Request Form. Please send as file(s) (*):
The picture will be uploaded to your project site

***The solicitation of a Labdoo laptop request implies that, upon receiving the laptops, the recipient agrees with the "Labdoo Laptop Recipient Agreement".

Labdoo Laptop Recipient Agreement:
====================================

Dear Laptop receiver:

We are very pleased to have the opportunity to contribute to your project by providing technology to help bridge the digital divide. 
With every right comes responsibilities. Technology, when adequately used, can provide very powerful means to aid those that are 
most in need. But if used improperly, it can also damage our environment. By receiving the above items, you are automatically accepting to abide by the following Labdoo global responsibilities:

(1) The items received will be used only for the purpose described by your organization at the time you solicited this donation. 
If you intend to use it for a different purpose, you will contact first the Labdoo team at contact@labdoo.org.

(2) In the case that an incidence occurs to any of the received items, you will contact the Labdoo team at contact@labdoo.org, 
including in your email the tagging number of the item(s) related to the incidence and a brief explanation. The following 
incidences must always be reported:
	(2.1) At the end of life of any of the received items, so that the item can be properly recycled. 
	(2.2) When an item breaks, malfunctions or any change in its status.

(3) Every six months, please send an email to contact@labdoo.org with the list of laptops that you have and their status (working or not working).

(4) Labdoo laptops are offered for free to you for education purposes.  In return, you agree to not use the laptops for commercial
reasons and you agree not to charge any fee for the usage of the laptops.  

(5) By returning this form filled in, the solicitor confirms owning all rights on sent materials (current or in the future) submitted to Labdoo.org and allowing such content to be publicly available from Labdoo.org. In addition, the solicitor confirms having approval for taking pictures of the children and/or any person benefiting from Labdoo laptops, tablets or any Labdoo donations, from their parents and/or legal guardians. Labdoo.org explicitly points to the fact that sent materials and pictures/photos may be used online and/or offline, and hence that they can be accessed by third parties, and that such pictures are used to help preserve the transparency and accountability of the projects.

We thank you for your commitment to make our world a better place and we wish you best of luck in your humanitarian mission.

The Labdoo Team.