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Mandatory information on this form is denoted by a *.
Organization Information
Site Name
Existing Member
Yes
No
Site Type
Regents Institution
Community College
Private College or University
Public School District
Library
Other
Contact Details
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Last Name
Title
Phone
Email
Billing Address
Address
City
State
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HI
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PA
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Zip Code
Service Address
Room
Building
Address
City
State
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AL
AK
AZ
AR
CA
CO
CT
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GA
HI
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IL
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MA
MI
MN
MS
MO
MT
NE
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NH
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NC
ND
OH
OK
OR
PA
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SD
TN
TX
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VA
WA
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WI
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Zip Code
Current Speed
Current Internet Provider
Service Type
Why is your site interested in KanREN a solution?
Network Connectivity
Yes
No
Preferred Bandwidth (if interested in a connectivity solution)
Applications (Video Hardware Selection, Scalable Video, Streaming)
Yes
No
Systems (Email, DNS and web hosting; Cloud Storage; and many more)
Yes
No
Rough Budget Estimate
E-Rate Eligible
Yes
No
Known Local Carriers
Special Technological Concerns
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