Education & Training Voucher Application by i7Xox0

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									Transitional Youth Services- ETV Application
AR ETV Office: (501)683-2162
                                    EDUCATION & TRAINING VOUCHER APPLICATION

                                    CONTACT INFORMATION
 Youth Name:                               Interview Date:               Date of Birth:              Youth Age:
 Click here to enter text.                 Click here to enter a date.   Click here to enter text.   Choose an item.
 Youth Address: Click here to enter text.
 City: Click here to enter text.                                Youth Phone: Click here to enter text.
 State: Click here to enter text.
 Zip Code: Click here to enter text.                            Alternate Phone: Click here to enter text.
 Area: Choose an item.
 Youth E-Mail Address:                 Has the student completed the Free Application for Federal Student Aid (FAFSA)?
 Click here to enter text.                                               Yes      NO


 Application Submitted: Click here to enter a date.           Interview Type: Choose an item.


                                       EDUCATIONAL GOALS
 What type of educational program does the student plan to enroll in?
 Choose an item.

 What School is the student currently attending or enrolled in:             What is the current Grade Level of the
 Click here to enter text.                                                  student?
                                                                            Choose an item.


                                                        What is the student’s declared Major (e.g. English, Political
                                                        Science, etc.)? Click here to enter text.



                                                        Does the student plan on attending Summer School (I, II, III)?

 Is the student currently enrolled or planning to       Yes       No

 enroll as a full-time or part-time student?
 Choose an item.
                                                        If they are a returning student, how are their classes going, are
                                                        they making Satisfactory Academic Progress?
                                                        Choose an item.


 When does the student expect to graduate? Click here to enter a date.




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Transitional Youth Services- ETV Application
AR ETV Office: (501)683-2162

                                          STUDENT PROFILE
 Does this student have a Drivers License?              What is the current living arrangement of the applicant?
 Choose an item.                                        Choose an item.

 Does the student consider it to be stable, safe, and appropriate?                   If applicant answered NO to the previous
 Yes      No                                                                          question, this issue must be addressed
                                                                                    immediately regardless of ETV eligibility
 Does the student need any assistance in the area of housing?                                     If yes in what area?
 Yes      No                                                                                      Choose an item.


 Is the student currently employed?                 Full-time or part-time?             Name of Employer?
 Yes      No                                        Choose an item.                     Click here to enter text.


 Is employment interfering with schoolwork?              Is employment considered something appropriate and needed at
 Yes      No                                             this time?
                                                         Yes       NO
 Does the student have connections with the              Does the student have support from a positive adult/friend?
 community?                                              Yes       NO         (Select all that apply)
 Yes      No                                             Choose an item.      Choose an item.    Choose an item.
 What connections to the community does           Follow-up required by ETV staff:
 the youth have?                                  Click here to enter text.
 Choose an item.


Additional Comments: Click here to enter text.


* I certify that the above information is true to the best of my knowledge.


Prepared By: Click here to enter text.                                     Date: Click here to enter a date.




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Transitional Youth Services- ETV Application
AR ETV Office: (501)683-2162

                       TRANSITIONAL YOUTH SERVICES
                            ETV BUDGET FORM
                                           Financial Awards
             Monthly Board Payment:             Click here to enter text.
             Pell Grant Award Amount:           Click here to enter text.
             Other Grant Amount:                Click here to enter text.
             Other Grant Amount:                Click here to enter text.
             * Loan amount:                     Click here to enter text.
             * Loan amount:                     Click here to enter text.
             Other Income:                      Click here to enter text.
             Other Income:                      Click here to enter text.
             Total Income:                      Click here to enter text.
                                               Other Expenses
             Date Applied For: Click here to enter a date.
             Tuition:                         Click here to enter text.
             Fees:                            Click here to enter text.
             Books:                           Click here to enter text.
             Total Anticipated Cost: Click here to enter text.
             Dorm Room/Rent:                  Click here to enter text.
             Utilities:                       Click here to enter text.
             Food:                            Click here to enter text.
             Transportation:                  Click here to enter text.
             Clothing:                        Click here to enter text.
             Personal Needs:                  Click here to enter text.
             Other:                           Click here to enter text.
             Total Anticipated Cost: Click here to enter text.
                                                Total Income – Total Expenses = Balance
                                             BALANCE: Click here to enter text.
                 If BALANCE is a negative amount, "Board Amount" can be adjusted upward
                         (The maximum payment allowable is $750 per month.)
                 If BALANCE is positive amount, "Board Amount" can be adjusted downward
             Prepared By: Click here to enter text.         Date: Click here to enter a date.

                         *Youth are not encouraged to take subsidized or unsubsidized loans




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Transitional Youth Services- ETV Application
AR ETV Office: (501)683-2162

                                                ETV Release Form

First Name: ________________________________________             Last Name: _______________________________________
Student Id:                Phone:                        Cell Phone:
____________________       (___) ____-___________        (___) _____-____________        Last 4 Digits of SS #:________


To Whom it May Concern:


I, ___________________________________ (print name) am applying for the Education and Training Voucher Program
(ETV), a federally funded program administered by the Arkansas Department of Human Services (DHS). In order to
receive this funding, the ETV staff at DHS may need access to my enrollment status, transcripts, invoice from the Business
Office and financial aid information from the Financial Aid office. I further authorize you to release information pertaining
to my enrollment status, grade history, and any other school related information to the Arkansas ETV program via mail,
telephone, email or facsimile.


Sincerely,


X________________________________________________             Date: ____/____/_________
Student Signature


                                    TO BE COMPLETED BY REPRESENATIVE OF
                                                FINANCIAL AID OFFICE ONLY

School/University Name: ___________________________           Payment Address: _________________________________
                                                                                 _________________________________
                                                                                 _________________________________
                                                                                 _________________________________


Student Status:     Full-Time       Part-Time    Current Semester:     Fall     Spring      Summer I       Summer II
Total # of hours enrolled in this Semester: _____        Has student completed FAFSA?         Yes     No




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Transitional Youth Services- ETV Application
AR ETV Office: (501)683-2162


Pell Grant Award Amount: $__________                                               Academic Probation
* If student is ineligible for the Pell Grant indicate reason why                  Less than Part-Time Status
                                                                                   Estimated Family Contribution (EFC)
                                                                                   Other:_________________________________

                                     Current Semester Financial Information
                                                   Subsidized Loans:          Offered                       Amount:$___________
Total Cost of Tuition :$________                                                   Accepted    Denied       Amount:$___________
                                                   Unsubsidized Loans:        Offered                       Amount:$___________
                                                                                   Accepted    Denied       Amount:$___________
                                                   Work Study:                     Accepted                 Amount:$___________
                                                   On- Campus Housing:             Dormitory
                                                      Yes      No                  Campus Apartment
Cost of Housing:$______________                                                    Other:______________
*Only complete if student is residing on campus    Off-Campus Housing:             Off-Campus Apartment
                                                      Yes      No                  Parent/Guardian
                                                                                   Other:______________
Cost of Meal Plan:$_____________
* Only complete if student is residing on campus
                             1.                                                                           Amount:$___________
Grants/Scholarships:         2.                                                                           Amount:$___________
                             3.                                                                           Amount:$___________


Total Cost of Attendance
                                                                                                          Amount:$___________
Including tuition, fees, room & board, transportation, books & supplies


Prepared By: X______________________________ Print Name: X____________________________                          Date: ___________


Phone Number: (____)_________________               Email Address: _________________________________________


                                                       Fax Completed Form To:
                                                      Transitional Youth Services
                                                            Attn: Renita Bennett
                                                               501-682-8823




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Transitional Youth Services- ETV Application
AR ETV Office: (501)683-2162
                                    ETV Participant’s Statement of Responsibility &
                                 Acknowledgement of Enrollment and School Attendance
Name: Click here to enter text.                                       Date of Birth: Click here to enter text.
Address:                                               City:                            State:                   Zip:
Click here to enter text.                              Click here to enter text.        Choose an item.          Click here to enter text.
                                                  Phone Number:                                  Alternate Phone Number:
Check box if this is a new address:               Click here to enter text.                      Click here to enter text.

Email Address: Click here to enter text.


           Initial each of the following to acknowledge your understanding and compliance with the AR ETV program:

           _____       I understand that The Education and Training Voucher (ETV) Program is a federally funded
                       program that is administered by the Arkansas Department of Human Services, Division of Children
                       & Family Services.

           _____       I confirm that I am currently enrolled in a college or vocational program and plan to attend the
                       following terms (Please check all that applies):

                          Fall                      Spring                     Summer I                   Summer II


           _____       I understand that the purpose of completing this form is to allow the AR ETV Program to determine
                       my eligibility for the AR ETV award.

           _____       I understand that the purpose of completing this form is to allow the AR ETV Program to process
                       payment of the AR ETV grant, if awarded.

           _____       I understand that it is my responsibility to budget my funds and that I will use ETV Funds ONLY for
                       ALLOWABLE expenses to include:

                            Allowable Expenses                                                    Non Allowable Expenses
          Residential housing                                                            Entertainment (movies, sports, video games, etc.)
          Room and board costs/food                                                      Non-school related electronics
          Tuition/fees                                                                   Furniture
          Books and related school supplies                                              Make up / cosmetics
          Childcare                                                                      Alcoholic beverages
          Transportation needs                                                           Tobacco
          Computer or other required equipment                                           Gift cards
          Medical insurance through school
           _____       I understand that it is my responsibility to update my address, phone number or any other contact
                       information with the AR ETV Office.
           _____       I have read and understand that my ETV award will be negatively impacted by “dropping”,
                       “withdrawing” or receiving an “incomplete” from more than ONE class during the current semester.
           _____       I have read and agree to the conditions listed above.

           ETV Program Participants’ Signature: _______________________________________                    Date: __/__/_____

                                            Please Return completed form to the AR ETV Office
                                                            Attention: AR ETV
                                                         P.O Box 1437-Slot S561
                                                          Little Rock, AR 72203




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         Transitional Youth Services- ETV Application
         AR ETV Office: (501)683-2162


                                                                  CHECKLIST
                        The following information is needed to complete your ETV application:
                               Completed ETV Application
                               Completed ETV Budget Form
                               Copy of High School Diploma, GED or Transcript
                               ETV Financial Aid Release Form (provided to financial aid office)
                               Copy of Financial Aid Award Letter (received from financial aid office)
                               Acceptance Letter (From University, College, Trade School, etc.)
                               Class Schedule (Upcoming Semester)
                               Bill (From Business Office)
                               Completed and signed Statement of Responsibility Form (Student)


                                                              Submit completed applications to:
                                                                 Renita.Bennett@arkansas.gov


----------------------------------------------------------------------------------------------------------------------------------------------------------------------------

                                                         FOR ETV OFFICE USE ONLY
                     Date Processed:                      Eligibility:               Amount Requested:                  Amount Approved:
                     Click here to enter a date.          Choose an item.            Click here to enter text.          Click here to enter text.


                     Purpose: Choose an item.                                        Other Information: Click here to enter text.




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Transitional Youth Services- ETV Application
AR ETV Office: (501)683-2162

         ETV Frequently Asked Questions
         How do I receive my ETV award for next semester?
         You can be awarded an ETV grant up to $2,500 each semester (as long as funding is available).
         In order to get your second award amount for this academic year, please make sure to complete
         the Checklist for Re-Determination (ETV Part II) form. You can get this form from your
         Transitional Youth Services Coordinator or Family Service Worker, or online at
         www.arkansasetv.org . The form will need to be completed at the end of your current semester in
         addition to submitting the required documents listed on the form.

         What can my ETV award be used for?
         ETV money will first pay for any tuition and fees that are owed to the school. After that, ETV can
         pay for anything related to your educational needs; including student loans, housing,
         transportation, computers, school supplies, daycare expenses and anything else that is going to
         assist you with completing your education. If you are unsure if an expense is allowable, please
         contact your Transitional Youth Services Coordinator or your Family Service Worker. They can
         provide you with a copy of an “Allowable Expenditures” sheet outlining commonly approved
         purchases.

         How will I re-apply Next Year?
         When re-applying next year, you will need to complete the ENTIRE ETV application packet
         again. You are not automatically enrolled to be re-awarded because you received previous ETV
         awards.

         What will I need to send in to re-apply?
         In addition to completing the application packet again, you will need to provide your grades,
         including your Cumulative Grade Point Average (GPA), which needs to be above a 2.0. You also
         need to send in receipts showing how your ENTIRE current ETV was spent. Without both of
         these items, you will not be re-awarded.

         What happens if I do not complete the classes I was enrolled in?
         When you re-apply, we will not only look at your GPA, but also look at the completion of your
         classes. Please be aware, if you have an incomplete or withdrew from more than ONE class per
         semester, you will not be awarded again until you complete a full semester. This means that,
         although your GPA may be above a 2.0, you are not guaranteed to be re-awarded.

         What do I do if I move or change phone numbers?
         You MUST contact the ETV Office when your contact information, including your mailing
         address and/or phone number changes. An ETV representative will be contacting you on a regular
         basis and they need to be able to get in touch with you. In addition, we also occasionally send out
         mailings to inform you of additional funding and resources, and these often have deadlines. If we
         can’t reach you, you cannot be fully informed.

         How do I get in touch with the ETV office when I want to send in
         information?
         You can call the office at 501-683-2162. Our fax number is 501-682-8823




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Transitional Youth Services- ETV Application
AR ETV Office: (501)683-2162

         Resources Available to Youth Pursuing a
         College Degree in Arkansas
         Free Application for Federal Student Aid
         All students must complete the Free Application for Federal Student Aid (FAFSA). Students can access
         online at http://www.fafsa.ed.gov or by calling the Federal Student Aid Information Center at 1-800-4-
         FED-AID. In order to receive the Pell grant for low-income students, loans or other aid, the student MUST
         complete the FAFSA.

         The Arkansas Challenge Scholarship
         The Academic Challenge Program provides scholarships to Arkansas residents pursuing a higher education. The
         program is primarily funded by the Arkansas Scholarship Lottery. The Academic Challenge Scholarship is
         available to students regardless of their academic status, whether just graduating from high school, currently
         enrolled in college, enrolling in college for the first time, or re-enrolling after a period of time out of college. Visit
         https://www.ark.org/adhe_financialaid/Login.aspx to complete the online application.

         The Arkansas Education and Training Vouchers (ETV)
         ETV provides up to $5,000 towards school-related costs and living fees. It is for youth that were in foster
         care after the age of 14. Contact your local DHS office, your Transitional Youth Services Coordinator,
         your Family Service Worker or the state ETV office at (501) 683-2162.

         Casey Family Scholars Program
         Casey provides scholarships of up to $10,000 for young people who spent at least 12 months in foster care
         and were not subsequently adopted. Check the OFA website at www.orphan.org .

         Ellen Carpenter HBCU Scholarship
         The Ellen Carpenter HBCU Scholarship Program is named for Ms. Ellen Carpenter, a graduate of Philander
         Smith and a long-time education and community activist and is available for students attending one of the
         following participating Arkansas Historically Black Colleges and Universities (HBCUs): Arkansas Baptist
         College, Philander Smith College or the University of Arkansas at Pine Bluff. The award amounts vary
         from $1000 to $5000 per year. Contact the financial aid offices for more information.

         Governor’s Scholars Program
         Up to $4000 annually for graduating high school seniors based on academic achievement, test score and
         leadership. The Governor’s Distinguished Scholarship for those scoring 32 on the ACT or 1410 on the
         SAT, and a 3.50 academic grade point average, or are named National Merit Finalists or National
         Achievement Scholar pays tuition, mandatory fees, room and board up to $10,000 per year. Complete
         YOUniversal Scholarship Application at https://www.ark.org/adhe_financialaid/Login.aspx.

         Higher Education Opportunities Grant (GO! Opportunities Grant)
         Go! Grants provide $1,000 grants to full-time and $500 grants to part-time students based on their financial
         need. Students must be an Arkansas resident for at least 12 months prior to applying for the grant. Students
         also must meet the financial need criteria established for the GO! Grant and attend an approved Arkansas
         institution. Applicants complete the Free Application for Federal Student Aid (FAFSA) and the GO!
         Opportunities Grant application. Complete the YOUniversal application at
         https://www.ark.org/adhe_financialaid/login.aspx.




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Transitional Youth Services- ETV Application
AR ETV Office: (501)683-2162
         GED Scholarship
         Awarded to first time entering students who score an average of 600 on the GED exam. Student must have
         taken the GED at an Arkansas test center. This scholarship may be renewed up to four semesters if a 3.0
         GPA is earned each semester with full-time enrollment (12 hours or more). Amount: Tuition & Fees
         Deadline to Apply: August 1 for fall and December 1 for spring Application: Apply online at
         www.gedscholarship.org.

         Arkansas Health Education Grant (ARHEG)
         This grant provides financial assistance to students seeking professional training in chiropractic medicine,
         dentistry, optometry, osteopathic medicine, podiatric medicine, and veterinary medicine to allow them to
         attend out-of-state institutions. Complete the YOUniversal application at
         https://www.ark.org/adhe_financialaid/login.aspx.

         Arkansas Governor’s Commission on People with Disabilities
         This grant is awarded to disabled Arkansas residents. Applicants must be a full-time student unless
         disability prevents full-time attendance. Amount: $1000 Deadline to Apply: February 27
         Application: Contact the Arkansas Rehabilitation Office at 501-296-1600



         School Specific Scholarships
         PULASKI TECHNICAL COLLEGE

               Ben Wyatt Scholarship
               Frank White Rotary Club of Little Rock Scholarship and Rotary Club of Little Rock
                Scholarship
             Harriet Frazer Scholarship
             Simmons First National Bank Endowed Scholarship
             Single Parent Scholarship Fund of Pulaski County (SPSF)
         APPLY FOR SCHOLARSHIPS AT: http://www.pulaskitech.edu/current_students/scholarships.asp


         SOUTHERN ARKANSAS UNIVERSITY

               Presidential
               University
               Blue & Gold
               Valedictorian/Salutatorian
               Top 10%
               Leadership Incentive Award
               Achievement Award
               Two-Year College
               Non-Traditional Student
               Art, Music, Theatre
               Departmental
         APPLY FOR SCHOLARSHIPS AT: http://web.saumag.edu/admissions/apply/scholarships/




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Transitional Youth Services- ETV Application
AR ETV Office: (501)683-2162
         UNIVERSITY OF CENTRAL ARKANSAS

                 UCA Transfer
                 UCA Distinguished
                 UCA Excellence
                 UCA Achievement
                 UCA University
                 UCA Leadership
         APPLY FOR SCHOLARSHIPS AT: http://www.uca.edu/admissions/academicscholarships.php

         UNIVERSITY OF ARKANSAS AT FAYETTEVILLE

               Chancellor’s
               Chancellor’s Merit
               Chancellor’s Community
               Silas Hunt
               Honors College Academy
               Razorback Bridge
               Leadership
               Freshman Academic
         APPLY FOR SCHOLARSHIPS AT : http://www.uark.edu/rd_vcaa/schl/1239.php

         HARVARD UNIVERSITY
         Harvard announced that undergraduate students from low-income families will no longer pay tuition! If
         you know of a family earning less than $65,000 a year with an honor student graduating from high school
         soon, Harvard University wants to pay the tuition.
         For more information visit:
         http://isites.harvard.edu/icb/icb.do?keyword=k51861&pageid=icb.page246751&pageContentId=icb.pageco
         ntent485705&state=maximize or contact the school's financial aid office.

         UNIVERSITY OF PHOENIX
         U of P is partnering with the National Foster Parent Association and will provide 50 full tuition
         scholarships for youth in foster care. For more information, visit:
         http://www.phoenix.edu/tuition_and_financial_options/scholarships/nfpa-scholarship.html.




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