SCN Digital Device Request

This form is intended for case managers or other providers serving participants in the city of Seattle. We are a volunteer-only operation so requests may take 2-4 weeks depending on inventory availability and volunteer capacity.

Stock will vary - please email devices@seattlecommunitynetwork.org for to confirm availability before submitting!

If you are requesting a device for yourself, please email devices@seattlecommunitynetwork.org and we will do our best to connect you with a service provider first.

Organization Information:

I am a case manager or other social service provider serving clients in the city of Seattle, and filling out on behalf of someone on my care roster

Organization Name

Organization Address (e.g. office or other location where devices can be dropped off)

Case Manager Name

Case Manager Email

Case Manager Phone

Participant Information:

The person I'm filling this out for is a senior, a student, low-income, unhoused, and/or unemployed looking for work, and they do not already have a device that meets their needs.

Further explanation of circumstances

The person I'm filling this out for has agreed to release their information, per my org's protocols

Participant name (or internal ID)

What device is needed?

Today's Date