Applicant Application

Your Information

Please provide information here

Primary Parent/Guardian

First Name*

Last Name*

Email Address*

Phone Number*

Address*

City*

Zip Code*

Second Parent/Guardian

First Name

Last Name

Email Address

Phone Number

Address

City

Zip Code

Account Creation

Username:*

Password:*

ConfirmPassword:*

Your Children

#	First Name	Last Name	Birth Date	SchoolName	Grade	Programs

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Your Financial Information

Financial Information

#	Verified	Relationship	First Name	Last Name	No Income	Earnings	Welfare	Retirement	Other	Total

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Name of person completing this form:*

Acknowlegement

By checking this box, I am acknowledging that the information and income provided in this application is true and accurate to the best of my knowledge.

Hardship Information

Loss of Income

Employment Change

Increased Medical Expenses

Increased Tuition Expenses

Increased General Expenses

Family Size Change

Loss of home/foreclosure

Bankruptcy

Other

Hardship Comments:

Your Documents

Documents

Please have the former school fill out this form and upload to your application. Public School Enrollment Verification
Upload a copy of military orders showing order to come to an Arizona station.
Upload a copy of the IEP, MET, or 504 plan from the Arizona public school you received it from.
Upload a completed copy of the DES Verification Form and an Information Release Form.
Upload a copy of your IEP, MET or 504 plan paperwork.
** If you accept ESA funds you will NOT be eligible for a JTO award for this school year. You may continue with this application if you have recommended funds and wish to have JTO consider you for a future award.

Upload your documents here. Please upload them in PDF format.

#	Document Filename

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