Emergency Broadband Benefit Form

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Emergency Broadband Benefit Form

TelAlaska is an approved participant in the Emergency Broadband Benefit (EBB) Program through our affiliates, Interior and Mukluk Telephone. The EBB Program is a Federal Communications Commission (FCC) program that provides a temporary discount on monthly broadband bills for qualifying low-income households. If you reside in a TelAlaska serving area, your household is on Tribal lands and you could be eligible to receive up to a $75/month discount on your internet service. Only one monthly service discount is allowed per household. The household may obtain broadband service supported by the EBB Program from any participating provider of their choosing, and the household may transfer their EBB Program benefit to another provider at any time. EBB Program enrollment begins on May 12, 2021.

"*" indicates required fields

I understand that the Emergency Broadband Benefit Program is a temporary emergency federal government benefit program operated by the FCC and will end when the fund runs out of money or six months after the Department of Health and Human Services declares an end to the COVID-19 health emergency, whichever is sooner. Please initial below.*

I provide affirmative consent to apply the Emergency Broadband Benefit to the service received from TelAlaska. Please initial below.*

As a participating household, I choose to opt-in to continue receiving broadband services from TelAlaska after the program ends. I understand by choosing to continue receiving service after the end of the Emergency Broadband Benefit Program, I will be billed TelAlaska’s regular monthly rate for internet service, subject to TelAlaska’s applicable terms and conditions. Please initial below.*

Name of Qualified Lifeline Applicant*

First Last

TelAlaska billing name or account number*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Call back number (if different)

Email*

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Please be advised that EBB Program enrollment begins on May 12, 2021. Additional information on the EBB Program can be found at www.fcc.gov/broadbandbenefit.

TelAlaska Customer Service
1-800-478-3127
customerservice@telalaska.com

Emergency Broadband Benefit Form

Emergency Broadband Benefit Form

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