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Special Needs Scholarship Program Student Eligibility Form

Please Note: The deadline for a public school student to use the private school choice option under the Special Needs Scholarship Program for the 2012 - 2013 school year was September 17, 2012. There are no exceptions to this deadline. This award amount is only provided for planning purposes for the 2013-2014 school year and is only an estimate.

Fields marked with an asterisk (*) are required.
*School Year:2012-2013
*System:
*School:
*First Name:
*Last Name:
*Date of Birth:(mm/dd/yyyy)