Current Page 1 Page 2 Preview 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 - Select -PrinceQueensKings Is the civic address/location of this project different from the address above? - Select -YesNo Civic Address Address City, Town or Community Postal Code For example C1B 0X0 or 12345 Applying as: - Select -Property OwnerLeaseholder with Approval from the Property Owner Are you a full-time permanent resident of PEI? - Select -YesNo You may not be eligible for this program. Review guidelines at the PEI Broadband Fund for Residents.