User account

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Account information

Username: *

Your preferred username; punctuation is not allowed except for periods, hyphens, and underscores.

E-mail address: *

A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.

Confirm e-mail address: *

Please re-type your e-mail address to confirm it is accurate.

Password: *

Confirm password: *

Provide a password for the new account in both fields.

Organization Activity

Activity Type: *

Select your organization's primary activity type.

Activity Code: *

Select your organization's primary activity code.

Organization Contact

First name: *

Enter the first name for your organization's primary contact.

Last name: *

Enter the last name for your organization's primary contact.

Job title: *

Enter the job title for your organization's primary contact.

Phone number:

Enter the phone number for your organization's primary contact.

E-mail address: *

Enter the e-mail address for your organization's primary contact.

Organisation Name *
Street Address *
Street Address 2
City *
Postal Code
County
Phone *
Fax
Website
	Please start the website address with 'http://' (e.g. 'http://www.YourOrganization.org')
Budget *
	Please enter your organisation's approximate annual budget. This information is a requirement of our donor partners. Please enter only numeric digits 0 through 9 in this field, and no letters or other characters. For example, enter "5000000", not "$5,000,000".

Organisation is non-exclusionary and non discriminatory *	Yes No
	I am willing and able to provide evidence that my organisation is non-exclusionary and non discriminatory.
Terms of eligibility *	Yes No
	I confirm that my organisation meets all the Eligibility Criteria.
Equipment request is authorized *	Yes No
	I am willing and able to provide evidence that a Director or Trustee of my organisation has requested the equipment.
IT Budget *	Yes No
	I am willing and able to provide evidence that my organisation has an identified IT budget:

Do you wish to receive:	Updates on the ENCLUDEit Programme? ENCLUDE News
How did you hear about us? *
Please Specify *
	Please specify source of referral.
Mission Statement
	Please enter your organisation's mission statement .
Number of computers for staff *
Date Qualified

Community served
Size of community served
What type of internet connection does the library have?
Does your library have?	Ethernet LAN Wireless LAN VPN (virtual private network) None of the above
Do you provide public access to the internet?	Yes No
Number of public terminals
Public Access Computer Warrant	I agree
	I will only request software donations for my public access computers, not for general administration.

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CHY number *
	This is a mandatory field that allows us to verify your organisations nonprofit status with the Irish Revenue Commissioners. You must have a valid CHY number to be eligible for the ENCLUDEit programme.