PEI Broadband Fund for Residents

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Prefill with your MyPEI Account

Allow this form to use information already in your MyPEI account to fill in fields automatically. You can review and edit everything before submitting.

Personal information on this form is collected under Section 31(c) of the Freedom of Information and Protection of Privacy Act R.S.P.E.I. 1988, c f-15.01 as it relates directly to and is necessary for determining eligibility. If you have any questions about this collection of personal information, you may contact the Innovation PEI Office by telephone at 1-800-563-3734 or by email at innovation@gov.pe.ca.

Identification

First Name

Middle Initial

Last Name

Address 1

Address 2

City, Town, or Community

Province

Postal Code

For example C1B 0X1 or 12345

Country

Telephone Number

For example 902-555-5555

Email Address

Cell Phone Number

For example 902-555-5555

County

Is the civic address/location of this project different from the address above?

Civic Address

Address

City, Town or Community

Postal Code

For example C1B 0X0 or 12345

Applying as:

Are you a full-time permanent resident of PEI?