Get a Tablet
+ FREE INTERNET!

APPLY NOW

Fill out this quick form to qualify

IMPORTANT: A verification of enrollment will be sent to you by text. Please verify your mobile number is correct

Select Eligibility Program*

Upload Award Letter* Click here to add your Award Letter (Proof of Benefit).

Qualifying Through Child or Dependent

Adult Signee

First Name*

Middle Initial

Last Name*

Suffix

Email*

Confirm Email*

Mobile Number*

Secondary Phone

Date of birth*

yyyy

Residence Address*

Apartment # or Suite #

City*

State*

Zipcode*

What is your shipping address? (Only fill this out if it is not the same as your home address.)

SSN (last 4 digits). If applicant does not have a SSN (and is applying under a Child or Dependents SSN) please enter "0000" as your SSN and upload a valid form of Government ID.*

Tribal ID

If required, click to add government ID (State ID, Drivers License, Passport, or Passport Card).

Organization

Sign by typing your name below:

I agree to the Terms and Conditions and Privacy Policy. By providing your mobile phone number, and checking the box, you consent to enroll in the Torch Wireless text messaging program and agree to receive automated text messages about your enrollment and account status. Message frequency may vary. There is no charge from Torch Wireless for this service. However, your service provider's message and data rates may apply. I have reviewed the ACP Consent here in and consent to all. I consent to my electronic signature be used to complete the required documentation to enroll in the Affordable Connectivity Program. I acknowledge that my PII will be transferred to NLAD to complete my ACP enrollment.

Get a Tablet + FREE INTERNET!

APPLY NOW

Adult Signee

Get a Tablet
+ FREE INTERNET!