This is not the ETV application. If we determine that you are or are likely eligible for ETV funding, you will still need to apply for ETV funding in order to actually receive funding.

First Name

Last Name

Email

Mobile Phone

Birthdate

In foster care at least one day on or after your 16th birthday Yes No

What state did you participate in DCS services? Indiana Arizona Maryland Ohio

Did you exit foster care via reunification YesNo

Are you less than 26 years old? Yes No

Have you received ETV funds in the past? Yes No

How many semesters did you receive ETV funding? 0-5 6-9 10+

Are you currently enrolled/planning on enrolling in college or a certificate program? Yes No

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