Initial Application

P a g e | 1 ETV ProgramJ.W. Fanning Institute for Leadership Development

INITIAL APPLICATION PACKET

Thank you for your interest in Georgia’s ETV program. This Application Packet, along with the below attachments, must be submitted in order to receive ETV funding for post-secondary education. Remember that ETV funding can only be used toward attending an accredited post-secondary institute. To see if your school is accredited, go to: http://ope.ed.gov/accreditation/search.aspx

Application Packet Checklist

Please submit your completed application and the attachments to Fanning via your online account. Refer to the “General Questions” document which provides a brief description on where to find these items.

ETV Application Form (below)

ETV Student Educational Agreement (below)

ETV Student Release Form (below)

Copy of high school diploma or GED transcript

Copy of acceptance letter to post-secondary school

Copy of FASFA Confirmation

Copy of financial aid package or award letter

Copy of cost of attendance (for post-secondary school)

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J.W. Fanning Institute for Leadership Development

Application Form

Basic Information

Name: Date of Birth:

Email

:

Phone:

Address: City, State: Zip:

High school: High school GPA:

Legal Status: Active foster care Adopted Prior foster care Other:

Consult with ILS for the following information

County of Foster Care Case:

SHINES #: Agency of Foster Care Case:

Case Worker’s Name: Case Workers Phone:

Post-secondary Institute Information

School Name:

Student ID #: Year in School:

Expected Graduation Date: Expected Major/Program:

Financial Aid Office Address: City, State: ZIP:

Please check the option that best describes your class schedule during the school term in which you are applying for funding (your individual school determines full-time status requirements): I am a full-time student ( credits) I am a part-time student ( credits)

Please check the option that best describes your living plans during the school term in which you are applying for funding: I plan to live on-campus I plan to live off-campus

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J.W. Fanning Institute for Leadership Development

ETV Student Educational Agreement

Student Name: Address: City, State: ZIP: SHINES #:

In order to be approved for the Education and Training Voucher (ETV) Program to help fund my post-secondary educational endeavors, I, , agree to the following conditions. (Please initial beside each commitment.)

I will not withdraw from classes without discussing it with my ILS and ETV staff.

I will complete and submit all necessary documentation according to the ETV application requirements.

I will maintain a full-time or part-time status at my post-secondary institution.

I will maintain a 2.0 cumulative GPA or the equivalent of passing grades and complete all classes each semester (an exception is made to one incomplete or withdrawal per semester).

I will send my grades into the ETV office after EACH semester.

I understand I can only access eligible ETV amounts during the term approved for funding.

I will contact the ETV program for address, phone, and/or email changes.

I will meet the goals, listed below, of this student educational agreement.

In the space below, please identify long-term educational and career goals:

Educational Goal:

Career Goal:

Youth Agreement

I, , agree to meet the terms and conditions of the Education and Training Voucher Program and will work toward successfully completing the course work at the school listed above. I also agree that all school documents that I have submitted are official. I understand that if any of the information that I have submitted is found to be fraudulent, I may be permanently ineligible for ETV funding. I confirm that I have read the eligibility requirements for the ETV Program funds.

If the above conditions are met, I may be eligible for funding UP TO $12,500 from the State of Georgia’s ETV program to support my documented need for post-secondary educational endeavors (this may include assistance with tuition, room and board, and personal miscellaneous expenses). Every situation is different and funding amounts vary based on many factors.

By signing below, I agree that I have been involved in the development of the student education agreement plan and accept responsibility for this plan. I understand that I must meet the above conditions, or I will not receive the education training voucher funds.

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J.W. Fanning Institute for Leadership Development

Signature: Date:

ETV Student Release Form (FERPA)

School/Program: Student Name: Student ID: Date: I have completed the FAFSA form (please circle one) YES NO

To Post-secondary Institute Officials:

I, , have applied for state funding towards my school costs. In order to receive this funding, the Education and Training Voucher (ETV) Program staff at the J.W. Fanning Institute for Leadership Development at the University of Georgia may need access to my:

Academic information (i.e. grades/GPA, registration, academic progress, enrollment status) Financial Aid information (i.e. awards, application data, disbursements) Student Account information (i.e. billing statements, charges, collection activity)

If requested, I authorize you to send a copy of my schedule, transcripts, and financial aid award letter to the Georgia ETV Program. I further authorize you to release information regarding my enrollment status, grade history, financial aid information, and student account information to the Georgia ETV Program via US Mail, telephone, fax, or online.

Sincerely,

Student signature: Date:

Georgia ETV Program OfficeJ.W. Fanning Institute for Leadership Development

ATTN: ETVUniversity of Georgia

1240 S. Lumpkin StreetAthens, GA 30602

Phone: (706)542-1108

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J.W. Fanning Institute for Leadership DevelopmentFax: 542-1744

Website: www.fanning.uga.eduEmail: etv@fanning.uga.edu