Skinny Jump Application Form
We will send you an automated copy of your responses to the email address that you provide below, but before you answer each question please make sure you read the explanatory details in each section about why we (Digital Inclusion Alliance and Stepping UP) are collecting this information and how we will use it.
In the first section, we need your name, address and contact details, so that if you meet the eligibility criteria we can send you a Skinny Jump modem. We may also use this information to contact you should we need to clarify any of your responses. This includes verifying that you are in a Skinny Jump coverage area.
This form may be completed by a Jump referral partner, with your information being provided by telephone.