Home Empowerment Scholarship Account ESA Parent Advisory Council Application ESA Parent Advisory Council Application Contact Information First Name Last Name What County do you live in? - Select -ApacheCochiseCoconinoGilaGrahamGreenleeLa PazMaricopaMohaveNavajoPimaPinalSanta CruzYavapaiYuma Preferred Phone Number Phone number of listed contact Preferred Email Application Information Please select your current status: - Select -I am a current ESA parentI am a former ESA parent My student qualified for the ESA program under the following eligibility category: Universal Student with Special Needs Parent is Active Duty Military Parent was Killed in the Line of Duty Parent is Legally Blind, Deaf or Hard of Hearing Attends a D or F Rated School Resides within a Native American Reservation Sibling of a Current or Previous Recipient Ward of Court Previous ESA Recipient Previous involvement with committees (Please include the name of the committee, dates served, and position held, if applicable): Briefly explain why you are interested in becoming a member and how your participation will support the purpose of the ESA Parent Advisory Council: Commitment - Select -YesNo Are you willing to commit to participate in the council for one year? Voluntary Information Ethnicity - None -African AmericanAsian/Pacific IslanderCaucasianLatinoNative AmericanOther Gender - None -MaleFemale This information is used solely for the purposes of ensuring committees are comprised of members reflecting the entire state of Arizona and its community. Date Submitted Submit Leave this field blank BU Sidebar ESA Home Apply for an ESA Eligibility Requirements Apply Now Application Status ESA Applicant Forms Learn More ESA Guidance ClassWallet Information Resources ESA Parent Handbook ESA Parent Advisory Committee ESA Law and Administrative Rules ESA Quarterly Reports Contact ESA HelpDesk Email: [email protected] Phone: (602) 364-1969 Contact Arizona Department of Education ESA Applicant Portal Access Contact Contact the Department