Online Referral
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<ul class="er_fld_row"><li class="er_fld_type_dropdown" draggable="false" style="width: 33.3333%;"><i class="fa fa-caret-down"></i><label class="er_fld_label">Application type</label><select name="CST_174"><option value="New Application">New Application</option><option value="Annual Updated Application">Annual Updated Application</option><option value="Change of phone/email/address/banking info">Change of phone/email/address/banking info</option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="CC_LastName" style="width: 100%;"> <i class="fa fa-font"></i><label class="er_fld_label required">Last Name</label><input name="CST_2" type="text" class="er_fld_required er_fld_copypre"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 100%;" map_to="CC_MiddleInitial"> <i class="fa fa-font"></i><label class="er_fld_label required">Middle Name</label><input name="CST_3" type="text" class="er_fld_required er_fld_copypre"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 100%;" map_to="CC_FirstName"> <i class="fa fa-font"></i><label class="er_fld_label required">First Name</label><input name="CST_4" type="text" class="er_fld_required er_fld_copypre"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="CC_Nickname" style="width: 33.3333%;"> <i class="fa fa-font"></i><label class="er_fld_label required">Preferred Name</label><input name="CST_5" type="text" class="er_fld_copypre er_fld_required"></li><li class="er_fld_type_paragraph er_fld_type_paragraph_small" draggable="false" style="width: 33.3333%;" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-paragraph"></i><label class="er_fld_label">Previous Names (as applicable-maiden, pre-adoptive, alias, prior married name, etc.)</label><textarea name="CST_24" style="width:100%;" class="er_fld_copypre"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown er_fld_showif" draggable="false" style="width: 25%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-caret-down"></i><label class="er_fld_label required">Are you currently enrolled and attending a college or vocational program?</label><select name="CST_152" class="er_fld_required er_fld_copypre"><option value="- Not Specified -">- Not Specified -</option><option value="Yes" selected="">Yes</option><option value="No">No</option></select></li><li class="er_fld_type_dropdown er_fld_showif" draggable="false" style="width: 25%;" er_fld_condfld="CST_152" er_fld_condvals="er_fld_showif_values=Yes"><i class="fa fa-caret-down"></i><label class="er_fld_label required">When will you start your next semester of classes?</label><select name="CST_161" class="er_fld_required er_fld_copypre"><option value="2025 Summer">2025 Summer</option><option value="2025 Fall" selected="">2025 Fall</option><option value="2026 Spring">2026 Spring</option><option value="2026 Summer">2026 Summer</option><option value="2026 Fall">2026 Fall</option><option value="2027 Spring">2027 Spring</option><option value="Unknown">Unknown</option><option value="Other">Other</option></select></li><li class="er_fld_type_dropdown er_fld_showif" draggable="false" style="width: 25%;" er_fld_condfld="CST_152" er_fld_condvals="er_fld_showif_values=No"><i class="fa fa-caret-down"></i><label class="er_fld_label required">When do you plan to start attending a college or vocational program?</label><select name="CST_164" class="er_fld_required er_fld_copypre"><option value="2025 Summer">2025 Summer</option><option value="2025 Fall" selected="">2025 Fall</option><option value="2026 Spring">2026 Spring</option><option value="2026 Summer">2026 Summer</option><option value="2026 Fall">2026 Fall</option><option value="2027 Spring">2027 Spring</option><option value="Unknown">Unknown</option><option value="Other">Other</option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_date er_fld_showif" draggable="false" style="width: 25%;" map_to="CC_DOB" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-calendar"></i><label class="er_fld_label required">Date of Birth</label><input class="cst_datepicker er_fld_required er_fld_copypre" name="CST_163" type="text"></li><li class="er_fld_type_dropdown er_fld_showif" draggable="false" map_to="CC_Gender" style="width: 25%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-caret-down"></i><label class="er_fld_label required">Gender</label><select name="CST_9" class="er_fld_required er_fld_copypre"><option value="- Not Specified -" selected="">- Not Specified -</option><option value="Male">Male</option><option value="Female">Female</option><option value="Non Binary">Non Binary</option></select></li><li class="er_fld_type_dropdown er_fld_showif" draggable="false" map_to="CC_Race" style="width: 25%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-caret-down"></i><label class="er_fld_label required">Race/Ethnicity</label><select name="CST_10" class="er_fld_required er_fld_copypre"><option value="- Not Specified -" selected="">- Not Specified -</option><option value="White/Caucasian">White/Caucasian</option><option value="Black/African American">Black/African American</option><option value="Mixed Race">Mixed Race</option><option value="Latino">Latino</option><option value="Native American">Native American</option><option value="Asian American">Asian American</option><option value="Pacific Islander">Pacific Islander</option><option value="Preferred not to say">Preferred not to say</option></select></li><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 25%;" er_fld_condfld="CST_10" er_fld_condvals="er_fld_showif_values=Other"> <i class="fa fa-font"></i><label class="er_fld_label required">Please enter your race if you marked Other for "Race/Ethnicity"</label><input name="CST_15" type="text" class="er_fld_required er_fld_copypre"></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown er_fld_showif" draggable="false" style="width: 33.3333%;" map_to="CC_PrimaryLanguage" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-caret-down"></i><label class="er_fld_label required">Primary Language</label><select name="CST_13" class="er_fld_required er_fld_copypre"><option value="- Not Specified -" selected="">- Not Specified -</option><option value="English">English</option><option value="Spanish">Spanish</option><option value="Other">Other</option></select></li><li class="er_fld_type_dropdown er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-caret-down"></i><label class="er_fld_label">Secondary Language</label><select name="CST_14" class="er_fld_copypre"><option value="- Not Specified -" selected="">- Not Specified -</option><option value="N/A">N/A</option><option value="English">English</option><option value="Spanish">Spanish</option><option value="Other">Other</option></select></li><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_13" er_fld_condvals="er_fld_showif_values=Other"> <i class="fa fa-font"></i><label class="er_fld_label required">Please enter your primary language if you selected "Other"</label><input name="CST_16" type="text" class="er_fld_required er_fld_copypre"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;" map_to="CC_PersonalPhone"> <i class="fa fa-font"></i><label class="er_fld_label required">Cell phone number</label><input name="CST_17" type="text" class="er_fld_required er_fld_copypre"></li><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;" map_to="CC_PersonalEmail"> <i class="fa fa-font"></i><label class="er_fld_label required">Primary email address</label><input name="CST_19" type="text" class="er_fld_required er_fld_copypre"></li><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;"> <i class="fa fa-font"></i><label class="er_fld_label required">Confirm email address</label><input name="CST_22" type="text" class="er_fld_required er_fld_copypre"></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown er_fld_showif" draggable="false" map_to="none" style="width: 25%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-caret-down"></i><label class="er_fld_label required">Citizenship Status</label><select name="CST_18" class="er_fld_required"><option value="- Not Specified -" selected="">- Not Specified -</option><option value="US Citizen">US Citizen</option><option value="Permanent Resident">Permanent Resident</option><option value="Unaccompanied Refugee Minor">Unaccompanied Refugee Minor</option></select></li><li class="er_fld_type_dropdown er_fld_showif" draggable="false" style="width: 25%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-caret-down"></i><label class="er_fld_label required">Do you have a social security number?</label><select name="CST_81" class="er_fld_required er_fld_copypre"><option value="- Not Specified -">- Not Specified -</option><option value="Yes">Yes</option><option value="No">No</option></select></li><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 25%;" er_fld_condfld="CST_81" er_fld_condvals="er_fld_showif_values=Yes" map_to="CC_SSN"> <i class="fa fa-font"></i><label class="er_fld_label required">Social Security Number</label><input name="CST_25" type="text" class="er_fld_required er_fld_copypre"></li><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 25%;" er_fld_condfld="CST_81" er_fld_condvals="er_fld_showif_values=No"> <i class="fa fa-font"></i><label class="er_fld_label required">A-Number</label><input name="CST_28" type="text" class="er_fld_required er_fld_copypre"></li></ul><ul class="er_fld_row"><li class="er_fld_type_section er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-header"></i><label>Housing Information</label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_section er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-header"></i><label>Mailing Address (Where we can send care packages to you while you are in school.)</label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="CC_School_Street_1" style="width: 50%;"> <i class="fa fa-font"></i><label class="er_fld_label required">Street Name & Number (include apartment number if applicable)</label><input name="CST_36" type="text" class="er_fld_required er_fld_copypre"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="CC_School_City" style="width: 33.3333%;"> <i class="fa fa-font"></i><label class="er_fld_label required">City</label><input name="CST_37" type="text" class="er_fld_required er_fld_copypre"></li><li class="er_fld_type_dropdown" draggable="false" map_to="CC_School_State" style="width: 33.3333%;"><i class="fa fa-caret-down"></i><label class="er_fld_label required">State</label><select name="CST_42" class="er_fld_required er_fld_copypre"><option value="- Not Specified -" selected="">- Not Specified -</option><option value="Alabama" selected="">Alabama</option><option value="Alaska">Alaska</option><option value="Arizona">Arizona</option><option value="Arkansas">Arkansas</option><option value="California">California</option><option value="Colorado">Colorado</option><option value="Connecticut">Connecticut</option><option value="Delaware">Delaware</option><option value="Florida">Florida</option><option value="Georgia">Georgia</option><option value="Hawaii">Hawaii</option><option value="Idaho">Idaho</option><option value="Illinois">Illinois</option><option value="Indiana">Indiana</option><option value="Iowa">Iowa</option><option value="Kansas">Kansas</option><option value="Kentucky">Kentucky</option><option value="Louisiana">Louisiana</option><option value="Maine">Maine</option><option value="Maryland">Maryland</option><option value="Massachusetts">Massachusetts</option><option value="Michigan">Michigan</option><option value="Minnesota">Minnesota</option><option value="Mississippi">Mississippi</option><option value="Missouri">Missouri</option><option value="Montana">Montana</option><option value="Nebraska">Nebraska</option><option value="Nevada">Nevada</option><option value="New Hampshire">New Hampshire</option><option value="New Jersey">New Jersey</option><option value="New Mexico">New Mexico</option><option value="New York">New York</option><option value="North Carolina">North Carolina</option><option value="North Dakota">North Dakota</option><option value="Ohio">Ohio</option><option value="Oklahoma">Oklahoma</option><option value="Oregon">Oregon</option><option value="Pennsylvania">Pennsylvania</option><option value="Rhode Island">Rhode Island</option><option value="South Carolina">South Carolina</option><option value="South Dakota">South Dakota</option><option value="Tennessee">Tennessee</option><option value="Texas">Texas</option><option value="Utah">Utah</option><option value="Vermont">Vermont</option><option value="Virginia">Virginia</option><option value="Washington">Washington</option><option value="West Virginia">West Virginia</option><option value="Wisconsin">Wisconsin</option><option value="Wyoming">Wyoming</option></select></li><li class="er_fld_type_text" draggable="false" map_to="CC_School_Zip" style="width: 33.3333%;"> <i class="fa fa-font"></i><label class="er_fld_label required">Zip Code</label><input name="CST_38" type="text" class="er_fld_required er_fld_copypre"></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-caret-down"></i><label class="er_fld_label required">Is your physical address the same as your mailing address?</label><select name="CST_47" class="er_fld_required er_fld_copypre"><option value="- Not Specified -">- Not Specified -</option><option value="Yes">Yes</option><option value="No">No</option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_text er_fld_showif" draggable="false" er_fld_condfld="CST_47" style="width: 50%;" er_fld_condvals="er_fld_showif_values=No"> <i class="fa fa-font"></i><label class="er_fld_label required">Physical Address: Street Name & Number (include apartment number if applicable)</label><input name="CST_44" type="text" class="er_fld_required er_fld_copypre"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 25%;" er_fld_condfld="CST_47" er_fld_condvals="er_fld_showif_values=No"> <i class="fa fa-font"></i><label class="er_fld_label required">Physical Address: City</label><input name="CST_45" type="text" class="er_fld_required er_fld_copypre"></li><li class="er_fld_type_dropdown er_fld_showif" draggable="false" er_fld_condfld="CST_47" er_fld_condvals="er_fld_showif_values=No" style="width: 25%;"><i class="fa fa-caret-down"></i><label class="er_fld_label required">Physical Address: State</label><select name="CST_48" class="er_fld_required er_fld_copypre"><option value="- Not Specified -" selected="">- Not Specified -</option><option value="Alabama">Alabama</option><option value="Alaska">Alaska</option><option value="Arizona">Arizona</option><option value="Arkansas">Arkansas</option><option value="California">California</option><option value="Colorado">Colorado</option><option value="Connecticut">Connecticut</option><option value="Delaware">Delaware</option><option value="Florida">Florida</option><option value="Georgia">Georgia</option><option value="Hawaii">Hawaii</option><option value="Idaho">Idaho</option><option value="Illinois">Illinois</option><option value="Indiana">Indiana</option><option value="Iowa">Iowa</option><option value="Kansas">Kansas</option><option value="Kentucky">Kentucky</option><option value="Louisiana">Louisiana</option><option value="Maine">Maine</option><option value="Maryland">Maryland</option><option value="Massachusetts">Massachusetts</option><option value="Michigan">Michigan</option><option value="Minnesota">Minnesota</option><option value="Mississippi">Mississippi</option><option value="Missouri">Missouri</option><option value="Montana">Montana</option><option value="Nebraska">Nebraska</option><option value="Nevada">Nevada</option><option value="New Hampshire">New Hampshire</option><option value="New Jersey">New Jersey</option><option value="New Mexico">New Mexico</option><option value="New York">New York</option><option value="North Carolina">North Carolina</option><option value="North Dakota">North Dakota</option><option value="Ohio">Ohio</option><option value="Oklahoma">Oklahoma</option><option value="Oregon">Oregon</option><option value="Pennsylvania">Pennsylvania</option><option value="Rhode Island">Rhode Island</option><option value="South Carolina">South Carolina</option><option value="South Dakota">South Dakota</option><option value="Tennessee">Tennessee</option><option value="Texas">Texas</option><option value="Utah">Utah</option><option value="Vermont">Vermont</option><option value="Virginia">Virginia</option><option value="Washington">Washington</option><option value="West Virginia">West Virginia</option><option value="Wisconsin">Wisconsin</option><option value="Wyoming">Wyoming</option></select></li><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 25%;" er_fld_condfld="CST_47" er_fld_condvals="er_fld_showif_values=No"> <i class="fa fa-font"></i><label class="er_fld_label required">Physical Address: Zip</label><input name="CST_46" type="text" class="er_fld_required er_fld_copypre"></li></ul><ul class="er_fld_row"><li class="er_fld_type_section er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-header"></i><label>Education Information</label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-font"></i><label class="er_fld_label required">High School graduated/graduating from</label><input name="CST_51" type="text" class="er_fld_required er_fld_copypre"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 25%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-font"></i><label class="er_fld_label required">High School City</label><input name="CST_52" type="text" class="er_fld_required er_fld_copypre"></li><li class="er_fld_type_dropdown er_fld_showif" draggable="false" style="width: 25%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-caret-down"></i><label class="er_fld_label required">High School State</label><select name="CST_53" class="er_fld_required er_fld_copypre"><option value="- Not Specified -" selected="">- Not Specified -</option><option value="Alabama" selected="">Alabama</option><option value="Alaska">Alaska</option><option value="Arizona">Arizona</option><option value="Arkansas">Arkansas</option><option value="California">California</option><option value="Colorado">Colorado</option><option value="Connecticut">Connecticut</option><option value="Delaware">Delaware</option><option value="Florida">Florida</option><option value="Georgia">Georgia</option><option value="Hawaii">Hawaii</option><option value="Idaho">Idaho</option><option value="Illinois">Illinois</option><option value="Indiana">Indiana</option><option value="Iowa">Iowa</option><option value="Kansas">Kansas</option><option value="Kentucky">Kentucky</option><option value="Louisiana">Louisiana</option><option value="Maine">Maine</option><option value="Maryland">Maryland</option><option value="Massachusetts">Massachusetts</option><option value="Michigan">Michigan</option><option value="Minnesota">Minnesota</option><option value="Mississippi">Mississippi</option><option value="Missouri">Missouri</option><option value="Montana">Montana</option><option value="Nebraska">Nebraska</option><option value="Nevada">Nevada</option><option value="New Hampshire">New Hampshire</option><option value="New Jersey">New Jersey</option><option value="New Mexico">New Mexico</option><option value="New York">New York</option><option value="North Carolina">North Carolina</option><option value="North Dakota">North Dakota</option><option value="Ohio">Ohio</option><option value="Oklahoma">Oklahoma</option><option value="Oregon">Oregon</option><option value="Pennsylvania">Pennsylvania</option><option value="Rhode Island">Rhode Island</option><option value="South Carolina">South Carolina</option><option value="South Dakota">South Dakota</option><option value="Tennessee">Tennessee</option><option value="Texas">Texas</option><option value="Utah">Utah</option><option value="Vermont">Vermont</option><option value="Virginia">Virginia</option><option value="Washington">Washington</option><option value="West Virginia">West Virginia</option><option value="Wisconsin">Wisconsin</option><option value="Wyoming">Wyoming</option></select></li><li class="er_fld_type_date er_fld_showif" draggable="false" style="width: 25%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-calendar"></i><label class="er_fld_label required">Date of High School Graduation/Anticipated Graduation OR GED Completion (month/year)</label><input class="cst_datepicker er_fld_required er_fld_copypre" name="CST_54" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_section er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-header"></i><label>College Information</label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 50%;" map_to="CC_School_Name" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-font"></i><label class="er_fld_label required">What college or vocational school are you planning to attend or currently attending?</label><input name="CST_57" type="text" class="er_fld_required er_fld_copypre"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-font"></i><label class="er_fld_label required">City of college or vocational school</label><input name="CST_58" type="text" class="er_fld_required er_fld_copypre"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-font"></i><label class="er_fld_label required">Degree Field/Major/Certification you are seeking</label><input name="CST_60" type="text" class="er_fld_required er_fld_copypre"></li><li class="er_fld_type_dropdown er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-caret-down"></i><label class="er_fld_label required">State of college or vocational school</label><select name="CST_59" class="er_fld_required er_fld_copypre"><option value="- Not Specified -" selected="">- Not Specified -</option><option value="Alabama" selected="">Alabama</option><option value="Alaska">Alaska</option><option value="Arizona">Arizona</option><option value="Arkansas">Arkansas</option><option value="California">California</option><option value="Colorado">Colorado</option><option value="Connecticut">Connecticut</option><option value="Delaware">Delaware</option><option value="Florida">Florida</option><option value="Georgia">Georgia</option><option value="Hawaii">Hawaii</option><option value="Idaho">Idaho</option><option value="Illinois">Illinois</option><option value="Indiana">Indiana</option><option value="Iowa">Iowa</option><option value="Kansas">Kansas</option><option value="Kentucky">Kentucky</option><option value="Louisiana">Louisiana</option><option value="Maine">Maine</option><option value="Maryland">Maryland</option><option value="Massachusetts">Massachusetts</option><option value="Michigan">Michigan</option><option value="Minnesota">Minnesota</option><option value="Mississippi">Mississippi</option><option value="Missouri">Missouri</option><option value="Montana">Montana</option><option value="Nebraska">Nebraska</option><option value="Nevada">Nevada</option><option value="New Hampshire">New Hampshire</option><option value="New Jersey">New Jersey</option><option value="New Mexico">New Mexico</option><option value="New York">New York</option><option value="North Carolina">North Carolina</option><option value="North Dakota">North Dakota</option><option value="Ohio">Ohio</option><option value="Oklahoma">Oklahoma</option><option value="Oregon">Oregon</option><option value="Pennsylvania">Pennsylvania</option><option value="Rhode Island">Rhode Island</option><option value="South Carolina">South Carolina</option><option value="South Dakota">South Dakota</option><option value="Tennessee">Tennessee</option><option value="Texas">Texas</option><option value="Utah">Utah</option><option value="Vermont">Vermont</option><option value="Virginia">Virginia</option><option value="Washington">Washington</option><option value="West Virginia">West Virginia</option><option value="Wisconsin">Wisconsin</option><option value="Wyoming">Wyoming</option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 100%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-font"></i><label class="er_fld_label">Name of additional college/institution (if taking classes at more than one college)</label><input name="CST_151" type="text" class="er_fld_copypre"></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown er_fld_showif" draggable="false" style="width: 25%;" er_fld_condfld="CST_152"><i class="fa fa-caret-down"></i><label class="er_fld_label required">Degree Type</label><select name="CST_61" class="er_fld_required er_fld_copypre"><option value="- Not Specified -" selected="">- Not Specified -</option><option value="Associate's Degree" selected="">Associate's Degree</option><option value="Bachelor's Degree">Bachelor's Degree</option><option value="Certificate">Certificate</option><option value="Other">Other</option></select></li><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 25%;" er_fld_condfld="CST_61" er_fld_condvals="er_fld_showif_values=Other"> <i class="fa fa-font"></i><label class="er_fld_label required">Degree Type (if selected "Other"</label><input name="CST_62" type="text" class="er_fld_required er_fld_copypre"></li><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 25%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-font"></i><label class="er_fld_label required">Anticipated Graduation date (ex: Spring 2027)</label><input name="CST_141" type="text" value="" class="er_fld_required er_fld_copypre"></li></ul><ul class="er_fld_row"><li class="er_fld_type_section er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-header"></i><label>FAFSA Information</label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-caret-down"></i><label class="er_fld_label required">Have you applied for Federal Financial Aid/FAFSA</label><select name="CST_66" class="er_fld_required er_fld_copypre"><option value="Yes">Yes</option><option value="No">No</option></select></li><li class="er_fld_type_date er_fld_showif" draggable="false" er_fld_condfld="CST_66" er_fld_condvals="er_fld_showif_values=Yes" style="width: 50%;"> <i class="fa fa-calendar"></i><label class="er_fld_label required">Date Completed FAFSA (month/year)</label><input class="cst_datepicker er_fld_required er_fld_copypre" name="CST_67" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_content er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_66" er_fld_condvals="er_fld_showif_values=No"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_warn">All students MUST submit a FAFSA application in order to receive Fostering Hope or ETV funding. </div></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small er_fld_showif" draggable="false" er_fld_condfld="CST_66" er_fld_condvals="er_fld_showif_values=No" style="width: 50%;"> <i class="fa fa-paragraph"></i><label class="er_fld_label required">If you have not completed the FAFSA, please explain why</label><textarea name="CST_68" style="width:100%;" class="er_fld_required er_fld_copypre"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_section er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-header"></i><label>Eligibility Determination Information</label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-caret-down"></i><label class="er_fld_label required">What state did you live in while you were in foster care?</label><select name="CST_69" class="er_fld_required er_fld_copypre"><option value="- Not Specified -" selected="">- Not Specified -</option><option value="Alabama">Alabama</option><option value="Alaska">Alaska</option><option value="Arizona">Arizona</option><option value="Arkansas">Arkansas</option><option value="California">California</option><option value="Colorado">Colorado</option><option value="Connecticut">Connecticut</option><option value="Delaware">Delaware</option><option value="Florida">Florida</option><option value="Georgia">Georgia</option><option value="Hawaii">Hawaii</option><option value="Idaho">Idaho</option><option value="Illinois">Illinois</option><option value="Indiana">Indiana</option><option value="Iowa">Iowa</option><option value="Kansas">Kansas</option><option value="Kentucky">Kentucky</option><option value="Louisiana">Louisiana</option><option value="Maine">Maine</option><option value="Maryland">Maryland</option><option value="Massachusetts">Massachusetts</option><option value="Michigan">Michigan</option><option value="Minnesota">Minnesota</option><option value="Mississippi">Mississippi</option><option value="Missouri">Missouri</option><option value="Montana">Montana</option><option value="Nebraska">Nebraska</option><option value="Nevada">Nevada</option><option value="New Hampshire">New Hampshire</option><option value="New Jersey">New Jersey</option><option value="New Mexico">New Mexico</option><option value="New York">New York</option><option value="North Carolina">North Carolina</option><option value="North Dakota">North Dakota</option><option value="Ohio">Ohio</option><option value="Oklahoma">Oklahoma</option><option value="Oregon">Oregon</option><option value="Pennsylvania">Pennsylvania</option><option value="Rhode Island">Rhode Island</option><option value="South Carolina">South Carolina</option><option value="South Dakota">South Dakota</option><option value="Tennessee">Tennessee</option><option value="Texas">Texas</option><option value="Utah">Utah</option><option value="Vermont">Vermont</option><option value="Virginia">Virginia</option><option value="Washington">Washington</option><option value="West Virginia">West Virginia</option><option value="Wisconsin">Wisconsin</option><option value="Wyoming">Wyoming</option></select></li><li class="er_fld_type_dropdown er_fld_showif" draggable="false" er_fld_condfld="CST_69" er_fld_condvals="er_fld_showif_values=Alabama" style="width: 33.3333%;"><i class="fa fa-caret-down"></i><label class="er_fld_label required">What county had your foster care case?</label><select name="CST_70" class="er_fld_required er_fld_copypre"><option value="- Not Specified -" selected="">- Not Specified -</option><option value="Autauga">Autauga</option><option value="Baldwin">Baldwin</option><option value="Barbour">Barbour</option><option value="Bibb">Bibb</option><option value="Blount">Blount</option><option value="Bullock">Bullock</option><option value="Butler">Butler</option><option value="Calhoun">Calhoun</option><option value="Chambers">Chambers</option><option value="Cherokee">Cherokee</option><option value="Chilton">Chilton</option><option value="Choctaw">Choctaw</option><option value="Clarke">Clarke</option><option value="Clay">Clay</option><option value="Cleburne">Cleburne</option><option value="Coffee">Coffee</option><option value="Colbert">Colbert</option><option value="Conecuh">Conecuh</option><option value="Coosa">Coosa</option><option value="Covington">Covington</option><option value="Crenshaw">Crenshaw</option><option value="Cullman">Cullman</option><option value="Dale">Dale</option><option value="Dallas">Dallas</option><option value="DeKalb">DeKalb</option><option value="Elmore">Elmore</option><option value="Escambia">Escambia</option><option value="Etowah">Etowah</option><option value="Fayette">Fayette</option><option value="Franklin">Franklin</option><option value="Geneva">Geneva</option><option value="Greene">Greene</option><option value="Hale">Hale</option><option value="Henry">Henry</option><option value="Houston">Houston</option><option value="Jackson">Jackson</option><option value="Jefferson">Jefferson</option><option value="Lamar">Lamar</option><option value="Lauderdale">Lauderdale</option><option value="Lawrence">Lawrence</option><option value="Lee">Lee</option><option value="Limestone">Limestone</option><option value="Lowndes">Lowndes</option><option value="Macon">Macon</option><option value="Madison">Madison</option><option value="Marengo">Marengo</option><option value="Marion">Marion</option><option value="Marshall">Marshall</option><option value="Mobile">Mobile</option><option value="Monroe">Monroe</option><option value="Montgomery">Montgomery</option><option value="Morgan">Morgan</option><option value="Perry">Perry</option><option value="Pickens">Pickens</option><option value="Pike">Pike</option><option value="Randolph">Randolph</option><option value="Russell">Russell</option><option value="St. Clair">St. Clair</option><option value="Shelby">Shelby</option><option value="Sumter">Sumter</option><option value="Talladega">Talladega</option><option value="Tallapoosa">Tallapoosa</option><option value="Tuscaloosa">Tuscaloosa</option><option value="Walker">Walker</option><option value="Washington">Washington</option><option value="Wilcox">Wilcox</option><option value="Winston">Winston</option><option value=""></option></select></li><li class="er_fld_type_text er_fld_showif" draggable="false" er_fld_condfld="CST_69" er_fld_condvals="er_fld_showif_values=Alaska&er_fld_showif_values=Arizona&er_fld_showif_values=Arkansas&er_fld_showif_values=California&er_fld_showif_values=Colorado&er_fld_showif_values=Connecticut&er_fld_showif_values=Delaware&er_fld_showif_values=Florida&er_fld_showif_values=Georgia&er_fld_showif_values=Hawaii&er_fld_showif_values=Idaho&er_fld_showif_values=Illinois&er_fld_showif_values=Indiana&er_fld_showif_values=Iowa&er_fld_showif_values=Kansas&er_fld_showif_values=Kentucky&er_fld_showif_values=Louisiana&er_fld_showif_values=Maine&er_fld_showif_values=Maryland&er_fld_showif_values=Massachusetts&er_fld_showif_values=Michigan&er_fld_showif_values=Minnesota&er_fld_showif_values=Mississippi&er_fld_showif_values=Missouri&er_fld_showif_values=Montana&er_fld_showif_values=Nebraska&er_fld_showif_values=Nevada&er_fld_showif_values=New+Hampshire&er_fld_showif_values=New+Jersey&er_fld_showif_values=New+Mexico&er_fld_showif_values=New+York&er_fld_showif_values=North+Carolina&er_fld_showif_values=North+Dakota&er_fld_showif_values=Ohio&er_fld_showif_values=Oklahoma&er_fld_showif_values=Oregon&er_fld_showif_values=Pennsylvania&er_fld_showif_values=Rhode+Island&er_fld_showif_values=South+Carolina&er_fld_showif_values=South+Dakota&er_fld_showif_values=Tennessee&er_fld_showif_values=Texas&er_fld_showif_values=Utah&er_fld_showif_values=Vermont&er_fld_showif_values=Virginia&er_fld_showif_values=Washington&er_fld_showif_values=West+Virginia&er_fld_showif_values=Wisconsin&er_fld_showif_values=Wyoming" style="width: 33.3333%;"> <i class="fa fa-font"></i><label class="er_fld_label required">Enter the name of the county that had your foster care case (if other state than AL)</label><input name="CST_71" type="text" class="er_fld_required er_fld_copypre"></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-caret-down"></i><label class="er_fld_label required">What funds are you applying for:</label><select name="CST_74" class="er_fld_required er_fld_copypre"><option value="Fostering Hope">Fostering Hope</option><option value="ETV">ETV</option><option value="Both Fostering Hope & ETV" selected="">Both Fostering Hope & ETV</option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_number er_fld_showif" draggable="false" style="width: 100%;" er_fld_condfld="CST_75" er_fld_condvals="er_fld_showif_values=No"> <i class="fa fa-hashtag"></i><label class="er_fld_label required">How old were you on the date of your adoption/permanent guardianship?</label><input name="CST_79" type="text" class="er_fld_required er_fld_copypre"></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-caret-down"></i><label class="er_fld_label required">Were you/will you be in foster care on your 18th birthday?</label><select name="CST_75" class="er_fld_required er_fld_copypre"><option value="- Not Specified -">- Not Specified -</option><option value="Yes">Yes</option><option value="No">No</option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-caret-down"></i><label class="er_fld_label required">Were you or will you be in foster care at the time of your high school/GED graduation?</label><select name="CST_78" class="er_fld_required er_fld_copypre"><option value="- Not Specified -">- Not Specified -</option><option value="Yes">Yes</option><option value="No">No</option></select></li><li class="er_fld_type_number er_fld_showif" draggable="false" er_fld_condfld="CST_78" er_fld_condvals="er_fld_showif_values=No" style="width: 33.3333%;"> <i class="fa fa-hashtag"></i><label class="er_fld_label required">How old were you on the date of your adoption/permanent guardianship?</label><input name="CST_80" type="text" class="er_fld_required er_fld_copypre"></li></ul><ul class="er_fld_row"><li class="er_fld_type_section er_fld_showif" draggable="false" style="width: 50%;" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application" er_fld_condfld="CST_174"><i class="fa fa-header"></i><label>Employment/Volunteer Status</label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-caret-down"></i><label class="er_fld_label required">Are you currently employed?</label><select name="CST_167" class="er_fld_required er_fld_copypre"><option value="Yes">Yes</option><option value="No">No</option></select></li><li class="er_fld_type_text er_fld_showif" draggable="false" map_to="CC_Employ_Employer" style="width: 33.3333%;" er_fld_condfld="CST_167" er_fld_condvals="er_fld_showif_values=Yes"> <i class="fa fa-font"></i><label class="er_fld_label required">Employer</label><input name="CST_84" type="text" class="er_fld_required er_fld_copypre"></li></ul><ul class="er_fld_row"><li class="er_fld_type_content er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_info er_fld_noprint">For students receiving Fostering Hope, the State of Alabama requires students to either volunteer 50 hours per semester OR work 5 hours per week to remain eligible to continue to receive Fostering Hope funds after your first year. </div></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown er_fld_showif" draggable="false" style="width: 14.2857%;" er_fld_condfld="CST_152" er_fld_condvals="er_fld_showif_values=Yes"><i class="fa fa-caret-down"></i><label class="er_fld_label required">Did you work during the last school year?</label><select name="CST_143" class="er_fld_copypre er_fld_required"><option value="Yes">Yes</option><option value="No">No</option></select></li><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 14.2857%;" er_fld_condfld="CST_143" er_fld_condvals="er_fld_showif_values=Yes"> <i class="fa fa-font"></i><label class="er_fld_label required">Name of employer(s) from the last school year</label><input name="CST_145" type="text" class="er_fld_required er_fld_copypre"></li><li class="er_fld_type_dropdown er_fld_showif" draggable="false" style="width: 14.2857%;" er_fld_condfld="CST_143" er_fld_condvals="er_fld_showif_values=Yes"><i class="fa fa-caret-down"></i><label class="er_fld_label required">Did you work at least 5 hours per week?</label><select name="CST_154" class="er_fld_required er_fld_copypre"><option value="Yes">Yes</option><option value="No">No</option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown er_fld_showif" draggable="false" style="width: 25%;" er_fld_condfld="CST_152" er_fld_condvals="er_fld_showif_values=Yes"><i class="fa fa-caret-down"></i><label class="er_fld_label required">Did you volunteer during the last school year?</label><select name="CST_157" class="er_fld_copypre er_fld_required"><option value="Yes">Yes</option><option value="No">No</option></select></li><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 25%;" er_fld_condfld="CST_157" er_fld_condvals="er_fld_showif_values=Yes"> <i class="fa fa-font"></i><label class="er_fld_label required">List your volunteer/service agency(s)</label><input name="CST_146" type="text" class="er_fld_copypre er_fld_required"></li><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 25%;" er_fld_condfld="CST_157" er_fld_condvals="er_fld_showif_values=Yes"> <i class="fa fa-font"></i><label class="er_fld_label required">Total number of volunteer hours for the last school year</label><input name="CST_147" type="text" class="er_fld_required er_fld_copypre"></li><li class="er_fld_type_dropdown er_fld_showif" draggable="false" style="width: 25%;" er_fld_condfld="CST_157" er_fld_condvals="er_fld_showif_values=Yes"><i class="fa fa-caret-down"></i><label class="er_fld_label required">Did you volunteer at least 50 hours per semester?</label><select name="CST_158" class="er_fld_required er_fld_copypre"><option value="Yes">Yes</option><option value="No">No</option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small er_fld_showif" draggable="false" style="width: 50%;" er_fld_condvals="er_fld_showif_values=Yes" er_fld_condfld="CST_152"> <i class="fa fa-paragraph"></i><label class="er_fld_label">Notes/Comments about volunteer hours or employment</label><textarea name="CST_149" style="width:100%;" class="er_fld_copypre"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_section er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-header"></i><label>Budget Worksheet</label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_content er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_bold">INCOME</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_content er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_bold"> INCOME TYPE</div></li><li class="er_fld_type_content er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_bold"> DOLLAR AMOUNT EARNED PER MONTH</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_content er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content"> Job/Work</div></li><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-font"></i><label class="er_fld_label required"></label><input name="CST_90" type="text" class="er_fld_required er_fld_copypre"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 25%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-font"></i><label class="er_fld_label">Other Income (if applicable)</label><input name="CST_170" type="text" value=""></li><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 25%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-font"></i><label class="er_fld_label">Amount per month</label><input name="CST_91" type="text" class="er_fld_copypre"></li></ul><ul class="er_fld_row"><li class="er_fld_type_content er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_bold"> TOTAL STUDENT INCOME</div></li><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-font"></i><label class="er_fld_label"></label><input name="CST_97" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_section" draggable="false" style="width: 100%;"><i class="fa fa-header"></i><label></label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_content er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_bold">EXPENSES</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_content er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_noprint er_fld_fontstyle_info">Please enter 0 if an expense does NOT apply to you. Please DO NOT enter NA for any item. If you're not sure, just make your best estimate.</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_content er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_bold"> EXPENSE TYPE</div></li><li class="er_fld_type_content er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_bold"> COST PER MONTH (dollar amount)</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_content er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content"> Rent/Housing</div></li><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-font"></i><label class="er_fld_label"></label><input name="CST_101" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_content er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content"> Utilities (Water, Electricity, Gas)</div></li><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-font"></i><label class="er_fld_label"></label><input name="CST_102" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_content er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content"> Phone/Internet</div></li><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-font"></i><label class="er_fld_label"></label><input name="CST_103" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_content er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content"> Food and groceries</div></li><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-font"></i><label class="er_fld_label"></label><input name="CST_104" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_content er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content"> Transportation (car, uber, other)</div></li><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-font"></i><label class="er_fld_label"></label><input name="CST_105" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_content er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content"> Personal needs</div></li><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-font"></i><label class="er_fld_label"></label><input name="CST_106" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_content er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content"> Health Insurance/Medical</div></li><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-font"></i><label class="er_fld_label"></label><input name="CST_107" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_content er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content"> Entertainment</div></li><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-font"></i><label class="er_fld_label"></label><input name="CST_108" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_content er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content"> Other</div></li><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-font"></i><label class="er_fld_label"></label><input name="CST_109" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_content er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_bold"> TOTAL STUDENT EXPENSES</div></li><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-font"></i><label class="er_fld_label"></label><input name="CST_118" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_section er_fld_showif" draggable="false" style="width: 100%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-header"></i><label></label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_section er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-header"></i><label>RELEASE OF INFORMATION</label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_content er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content">Release of information/Authorization to receive electronic communications.</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_content er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_warn">Authorization and Release of Information: I hereby authorize Embrace Alabama Kids to receive and release information as it pertains to my financial aid status, grades, enrollment status, academic status, progress, graduation information or other information required to determine my ongoing eligibility for Education and Training Vouchers (ETV fund) and/or the Fostering Hope Scholarship as well as other scholarships Embrace AL Kids may be administering to and from the school(s) listed in this application. I understand that all information will be treated as confidential and privileged and used only for the purpose of monitoring my eligibility to receive ETV and or Fostering Hope funds by the entity indicated above. Your rights, as a client, with respect to this authorization: 1. Inspect or copy the information to be used or disclosed 2. Receive a copy of this information 3. Refuse to sign this authorization 4. Withdraw this authorization after it’s signed. You may give written notice to your EAK/UMCH worker to withdraw your authorization. Withdrawals of this authorization will be effective the date EAK/UMCH receives written notification of your intent to withdraw. FERPA Consent Embrace Alabama Kids will access the National Student Clearinghouse. (1) Records that may be disclosed: Student Transcript, proof of enrollment, proof of graduation/ completion of secondary education and/or training (2) Purpose of the disclosure: Verify eligibility for grant, scholarship, and other funds; Verify completion of secondary education/training (3) Identify the party or class of parties to whom the disclosure may be made: Embrace AL Kids will provide data obtained from the National Student Clearinghouse to the Alabama Department of Human Resources as part of aggregate reporting and may also provide individual information related to academic progress as well as graduation/completion information to confirm on-going eligibility for Fostering Hope and/or ETV funding. </div></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox er_fld_showif" style="white-space: normal; width: 50%;" draggable="false" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">Release of Information Timeframe</label> <label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_136" value="I understand that this authorization is in effect as of the signature date on this document and is valid for one year.">I understand that this authorization is in effect as of the signature date on this document and is valid for one year.</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_136" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_136_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox er_fld_showif" style="white-space: normal; width: 50%;" draggable="false" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">Verification</label> <label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_137" value="I attest that the information I have provided is true and correct.">I attest that the information I have provided is true and correct.</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_137" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_137_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox er_fld_showif" style="white-space: normal; width: 50%;" draggable="false" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">Communication Consent</label> <label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_138" value="I consent to receive communication via cell phone and email.">I consent to receive communication via cell phone and email.</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_138" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_138_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_section er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-header"></i><label>Requirements </label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_content er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_warn">If awarded Fostering Hope (FH) Funding, I understand the following: 1. FH funding will be sent directly to my school's financial aid office, and it is for tuition and tuition related fees only. 2. FH money is intended to reduce the amount of loans whenever possible. 3. It will take from 10 to 21 business days for the school to apply FH funding to my account. 4. The Alabama Fostering Hope Scholarship is a state-funded grant program. To remain eligible for funding, I must be in good standing with my school. 5. Once my final grades have been posted for the semester, I am required to provide a copy of my transcript. 6. I will be required to report my volunteer and/or work hours upon reapplication. The State of Alabama requires students to either volunteer 50 hours per semester OR work 5 hours per week to remain eligible to continue to receive Fostering Hope funds.</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_content er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_warn">If awarded Educational and Training Vouchers (ETV) Funding, I understand the following: 1. I must be enrolled, attending classes and in good standing with my school. 2. ETV funds should be used for school-related expenses. It is important to budget my money, so it lasts for the full term/semester. (If you need help with budgeting, please contact your coordinator - budgeting is an important skill everyone must learn.) 3. ETV money is intended to reduce or replace loans whenever possible. ETV funds will be sent directly to my school. If I have taken a student loan, it is my responsibility to repay the loan with any ETV funds that are returned to me. 4. ETV funding is awarded each semester based on funding availability. No student is guaranteed ETV funding or a specific funding amount.</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox er_fld_showif" style="white-space: normal; width: 50%;" draggable="false" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">Acknowledgement of Fostering Hope and ETV Requirements</label> <label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_168" value="I have read and understand the requirements listed above.">I have read and understand the requirements listed above.</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_168" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_168_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox er_fld_showif" style="white-space: normal; width: 50%;" draggable="false" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">Acceptance of Potential Funding </label> <label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_169" value="If awarded Fostering Hope and/or ETV funding, I authorize Support for Success/Embrace AL Kids to release awarded funds on my behalf. I understand this agreement does not guarantee funding.">If awarded Fostering Hope and/or ETV funding, I authorize Support for Success/Embrace AL Kids to release awarded funds on my behalf. I understand this agreement does not guarantee funding.</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_169" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_169_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_content er_fld_showif" draggable="false" style="width: 50%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_info">Please provide direct deposit information in the event we need to disburse funds directly to you.</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_169" er_fld_condvals="er_fld_showif_values=If+awarded+Fostering+Hope+and%2For+ETV+funding%2C+I+authorize+Support+for+Success%2FEmbrace+AL+Kids+to+release+awarded+funds+on+my+behalf.+I+understand+this+agreement+does+not+guarantee+funding."><i class="fa fa-caret-down"></i><label class="er_fld_label required">Type of Account</label><select name="CST_171" class="er_fld_required er_fld_copypre"><option value="Checking">Checking</option><option value="Savings">Savings</option><option value="N/A- No bank account, will need paper check">N/A- No bank account, will need paper check</option></select></li><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_171" er_fld_condvals="er_fld_showif_values=Checking&er_fld_showif_values=Savings"> <i class="fa fa-font"></i><label class="er_fld_label required">Bank Routing Number</label><input name="CST_172" type="text" class="er_fld_required er_fld_copypre"></li><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_171" er_fld_condvals="er_fld_showif_values=Checking&er_fld_showif_values=Savings"> <i class="fa fa-font"></i><label class="er_fld_label required">Account number</label><input name="CST_173" type="text" class="er_fld_required er_fld_copypre"></li></ul><ul class="er_fld_row"><li class="er_fld_type_content er_fld_showif" draggable="false" style="width: 33.3333%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_info">Do your best to caputure your signature using your mouse, finger, or stylus depending on the device you are using. If you cannot see a submit button under the signature field, please email s4s@emabracealkids.org for additional guidance.</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_signature er_fld_showif" draggable="false" style="width: 100%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application"> <i class="fa fa-pencil"></i><label class="er_fld_label required">Signature</label><div class="cst_signaturepad"></div><input name="CST_139" type="text" class="er_fld_required"><button class="type_button" disabled="">Clear Signature</button></li></ul><ul class="er_fld_row"><li class="er_fld_type_date er_fld_selected er_fld_showif" draggable="false" style="width: 100%;" er_fld_condfld="CST_174" er_fld_condvals="er_fld_showif_values=New+Application&er_fld_showif_values=Annual+Updated+Application"> <i class="fa fa-calendar"></i><label class="er_fld_label required">Date of Signature</label><input class="cst_datepicker er_fld_required" name="CST_166" type="text" value=""></li></ul>
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