Affordable Connectivity Program (ACP) Outreach and Enrollment Event Interest Form

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The Affordable Connectivity Program (ACP) is a federal program that provides a $30 per month discount on internet service to eligible households. Only 36% of eligible households in the Chippewa Valley are enrolled in the ACP.

United Way of the Greater Chippewa Valley partners with community organizations to host ACP outreach and enrollment events.

If your organization would like to host an ACP outreach or enrollment event, please complete this form. Someone from United Way of the Greater Chippewa Valley will follow up with you to schedule an event.

Organization Name

Contact First Name

Contact Last Name

Contact Email

Contact Phone

Is your organization interested in hosting an ACP outreach event, enrollment event or both?

Outreach Event

Enrollment Event

Both

Please list a few dates and times you would like to schedule the ACP outreach and/or enrollment event. (NOTE: ACP events last between 1-4 hours.)

How many people do you expect or hope participate in the ACP outreach and/or enrollment event?

Can your organization provide one or more staff members to help facilitate the ACP event? (This is not required.)

Yes

Does your organization have internet access that can be used during the ACP event? (This is not required but may increase logistical needs.)

Yes

Who is the primary audience for the ACP event?

Community members who may qualify for the ACP.

Community leaders who want to learn how to enroll clients in the ACP.

Other:

Will English be the primary language spoken at the ACP event?

Yes

Will your ACP event require a translator for a language other than English spoken at the event?

Yes

Maybe

If your ACP event requires a translator for a language other than English, what language(s) do you need a translator for?

In addition to the ACP, would you like any of the following additional resources at the event?

Refurbished Device Distribution

Digital Skills Support

Other:

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