Child Education Support Application FY25-26

Child Member must have Tailored Plan Medicaid.


Child Member must be enrolled in grades Pre-K through 12.

 

Applicant Information

 

Please include first and last name.

 
 
mm/dd/yyyy
 

Please include the full address with street, city and zip code

 

Please choose one.

 

Please enter the full name of your child's school

 
 
 

Please enter your full name below so we know who is applying on behalf of this child.

 

Please choose one

 

Please enter your phone number in case we need to get in touch with you.

Phone
 

Please enter your email address in case we need to get in touch with you.