Internet Essential Partnership Program Request

Please fill out this form when you are requesting sponsored services.

Name of Organization*

Used for Billing Account creation

Primary Organization Contact Name*

Used for Billing Account creation

Primary Organization Contact Email*

Used for Billing Account creation

Sponsor Phone Number*

Used for Billing Account creation

School District/Library ID*

For help locating your School District ID please see https://nces.ed.gov/ccd/schoolsearch/index.asp. Any Non School Organizations please type N/A.

Address 1*

Address should be physical address for the Master billing account, no PO boxes

Address 2

City*

State*

Select

Zip Code*

Field Contact*

If you have been working with a Comcast Field Rep please add their name here. Otherwise type N/A.

Agreement Start Date*

The date that you would like your agreement to start

Agreement Expiration Date*

The date that you would like your agreement to end

Service Payor*

The type of organization that will be responsible for paying monthly service charges.

Select

Service Receiver*

The type of organization or individual that will be receiving the services paid for by the Sponsor.

Select

ECF

Please check this if you have already or will be applying for the Emergency Connectivity Fund

ECF Application Number

This is used for applications that get approved for ECF

Federal Registration Number (FRN) NUMBERS ONLY

E-Rate

Please check this box if the sponsor is an existing E-Rate customer

Potential Number Sponsoring*

Minimum sponsorship is 25 end-users for 6 months

Lead Notes*

i.e. Preferred Method and Time of Contact, Alternate Contact Information

File Upload

i.e. School/Organization Logo, Service Area Zip Code List, Purchase Order, Tax Exempt Form (including helpful documentation may help decrease Onboarding Process time)

Drag and drop files here or

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