Please submit all completed forms to [email protected]
Starting October 1st, 2019 — ESA will no longer accept paper applications. This application must be submitted online.
(to be used when applying for ESA)
- For proof of residency you can utilize the Affidavit of Shared Residence Form.
- If applying under Legal Guardian is Blind: Blindness Confirmation Form
- If applying under Legally Deaf/Hard of Hearing: Confirmation of Deaf or Hard of Hearing
Current Recipient Forms
(for parents currently using ESA)
- To add an additional parent/guardian: Additional Parent/Guardian Request Form
- To remove a Student from the ESA Program: Close Account Request Form
- To appeal the department’s decision reference: Example of Appeal Letter from Applicant
- Click here to Download the ESA Brochure
- Example of itemized invoice.
- Printable FAQ – Word | PDF
- Funding Chart – Approximate ESA Award Amounts
Expense Report Paper Forms
Starting October 1st, 2019 (Quarter 2) — ESA will no longer accept paper Expense Reports. Expenses must be submitted through the online portal.
Prepare for this Change by:
icon Important There are three kinds of expense report forms:
- If you only pay private school expenses (tuition, textbooks, fees, and uniforms), complete the Private School Only Expense Report
- If you have student without a disability and spend in multiple categories (tutoring, curricula, etc.), complete the General Expense Report
- If you have a student with a disability and utilize therapies and services, complete the Student with Disability Expense Report
- Example of itemized invoice.
icon ImportantComplete Submission Requirements:
An incomplete submission will not be accepted by ESA (in-person, by postal mail, or e-mail).
- You must provide all of the following:
- You are required to complete this form by hand. ESA will not accept digital signatures for this form.
- The completed Expense Report Form.
- An itemized invoice (this includes the student’s name, the vendor name, the service or item paid for, and payment date).
- You can view an example here.
- Current credentials, if applicable, must be provided with each quarter even if they have been provided previously.
- It is the Account Holder’s responsibility to verify the credentials are current each quarter.
- ESA will not accept an e-mail with your invoice or receipts only. This is not how you submit your Quarterly Expense Report.
- If you are submitting your report in-person, ESA is unable to make copies for you. Make sure that what you bring is what ESA can keep. (We do not recommend providing originals.)
- If you are submitting your report in-person, ESA is unable to verify that all the required documents are being turned in at that same time.
- (If dropping off or mailing to ESA make sure you already have copies, ESA will not provide copies of your documents.)
- ESA strongly recommends comparing your expense report to your ESA Prepaid Card Bank Statement to make sure all expenses and additional documentation are accounted for.
- If your submission is incomplete, ESA will reach out to notify you that it cannot be submitted without all the required documentation. If the expense report is not submitted on time, that can result in account suspension, termination, and fund forfeiture (sections 3 and 4. D. of the contract and Chapter 6 of the Parent Handbook).
Need more Space?
Print and complete the appropriate addendum sheet for adding more line items:
- Extra Curricula Purchases Addendum Sheet
- Extra Tutoring Services Addendum Sheet
- Extra Educational Therapy and Services Addendum Sheet
- Extra Paraprofessional Addendum Sheet