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ETV Program
J.W. Fanning Institute for Leadership Development
INITIAL APPLICATIONPACKET
Thank you for your interest in Georgia’s ETV program. This Application Packet, along with the below
attachments, must be submitted in order to receive ETV funding for post-secondary education. Remember
that ETV funding can only be used toward attending an accredited post-secondary institute. To see if your
school is accredited, go to: http://ope.ed.gov/accreditation/search.aspx
Application Packet Checklist
Please submit your completed application and the attachments to Fanning via your online account. Refer to
the “General Questions” document which provides a brief description on where to find these items.
 ETV Application Form (below)
 ETV Student Educational Agreement (below)
 ETV Student Release Form (below)
 Copy of high school diploma or GED transcript
 Copy of acceptance letter to post-secondary school
 Copy of FASFA Confirmation
 Copy of financial aid package or award letter
 Copy of cost of attendance (for post-secondary school)

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ETV Program
J.W. Fanning Institute for Leadership Development
Application Form
Basic Information
Name: Date of Birth:
Email: Phone:
Address: City,State: Zip:
Highschool: Highschool GPA:
Legal Status:
Active fostercare Adopted Priorfostercare Other:
Consult with ILS for the following information
Countyof FosterCare Case:
SHINES#: Agencyof FosterCare Case:
Case Worker’sName: Case WorkersPhone:
Post-secondary Institute Information
School Name:
StudentID#: Year inSchool:
ExpectedGraduationDate: ExpectedMajor/Program:
Financial AidOffice Address: City,State: ZIP:
Please checkthe optionthatbestdescribesyourclassscheduleduringthe school terminwhichyouare applyingfor
funding(yourindividual school determinesfull-time statusrequirements):
I am a full-time student ( credits) I am a part-time student ( credits)
Please checkthe optionthatbestdescribesyourlivingplansduringthe school terminwhichyouare applyingfor
funding:
I planto live on-campus I planto live off-campus

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ETV Program
J.W. Fanning Institute for Leadership Development
ETV Student Educational Agreement
Student Name:
Address: City, State: ZIP:
SHINES #:
In order to be approved for the Education and Training Voucher(ETV) Program to help fund my post-secondary
educational endeavors, I, , agree to the followingconditions. (Please
initial besideeachcommitment.)
I will not withdraw from classes without discussing it with my ILS and ETVstaff.
I will complete and submit all necessary documentation accordingto the ETVapplication requirements.
I will maintain a full-time or part-time status at my post-secondary institution.
I will maintain a 2.0 cumulative GPAor the equivalent of passing grades and complete all classes each
semester (an exception is made to one incomplete or withdrawal per semester).
I will send my grades into the ETVofficeafterEACH semester.
I understand I can only access eligible ETV amounts during the term approved forfunding.
I will contactthe ETV program for address, phone, and/or email changes.
I will meet the goals, listed below, of this student educational agreement.
In the space below, please identify long-term educational and career goals:
Educational Goal:
Career Goal:
YouthAgreement
I, , agree to meet the terms and conditions of the Education and Training
Voucher Program and will work toward successfully completing the course work at the school listed above.I also agree that all school
documents that I have submitted are official. I understand that if any of the information that I have submitted is found tobe fraudulent,I may
be permanently ineligible for ETV funding.I confirm that I have read the eligibility requirements for the ETV Program funds.
If the above conditions are met, I may be eligible for funding UP TO $12,500 from the State of Georgia’s ETV program to support my
documented need for post-secondary educationalendeavors (this may include assistance with tuition, room and board,and personal
miscellaneous expenses).Every situation is different and funding amounts vary based on many factors.
By signing below, I agree that I have been involved in the development of the student education agreement plan and accept responsibility for
this plan.I understand that I must meet the above conditions, or I will not receive the education training voucher funds.
Signature: Date:

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ETV Program
J.W. Fanning Institute for Leadership Development
ETV Student Release Form (FERPA)
School/Program:
Student Name: Student ID:
Date:
I have completed the FAFSA form (please circle one) YES NO
To Post-secondary Institute Officials:
I, , have applied for state funding towards my school
costs. In order to receive this funding, the Education and Training Voucher (ETV) Program staff at the J.W.
Fanning Institute for Leadership Development at the University of Georgia may need access to my:
 Academic information (i.e. grades/GPA, registration, academic progress, enrollment status)
 Financial Aid information (i.e. awards, application data, disbursements)
 Student Account information (i.e. billing statements, charges, collection activity)
If requested, I authorize you to send a copy of my schedule, transcripts, and financial aid award letter to the
Georgia ETV Program. I further authorize you to release information regarding my enrollment status, grade
history, financial aid information, and student account information to the Georgia ETV Program via US Mail,
telephone, fax, or online.
Sincerely,
Student signature: Date:
Georgia ETV Program Office
J.W. Fanning Institute for Leadership Development
ATTN: ETV
University of Georgia
1240 S. Lumpkin Street
Athens, GA 30602
Phone: (706)542-1108
Fax: 542-1744
Website: www.fanning.uga.edu
Email: etv@fanning.uga.edu