OPEN ENROLLMENT PERIOD 3 - 2016
EDUCATION SAVINGS ACCOUNT APPLICATION (ESA)
During the process of filling out this application you will be asked to select files for upload.
However, the application will not be considered for approval until necessary files have been
received by the Treasurer's office.
We ask that you do not attempt to upload cell phone photos.
School District Student ID#   
Student First Name: 
Student Last Name: 
Current Grade (2014-2015):    
(Please enter a number, i.e., 2,3,4..., use a 0 for kindergarden)
Student's Date of Birth:   
(Date Format MM/DD/YYYY)
Physical Address (P.O. Boxes will not be accepted): 
City: 
Zip Code:   
County: 
Phone (Include Area Code): 
Mailing Address: 
City:  
Zip Code:   
Applicant
Parent First Name: 
Parent Last Name: 
Parent E-Mail Address:   
 
Do you and your child reside in Nevada? 
Is your child under the age of 7 years? 
Did the student attend a Nevada public/charter school for 100 school days immediately preceding the date of this application?  
Was your child a full time student during the required 100 school days immediately preceding the date of this application? 
During the 100 school days immediately preceding the date of this application did your child miss 15 or more consecutive school days (e.g., illness, special circumstances)?
If yes, please attach a detailed explanation of the extended absence.