Children's Savings Account Disbursement Form

Are you ready to start your post-secondary journey? Complete this form to request access for your Children's Savings Account (CSA) dollars. Your answers will only be shared with CSA program staff. You will receive an email from program staff with confirmation of receipt of your disbursement request. Please note that it can take up to 60 days for you to receive your CSA money once staff confirms your disbursement request submission.

I self-certify that I have met the requirements of the Children's Savings Account Program in order to receive my savings account disbursement: *

Completed a high school diploma or GED certificate

Enrolled into a post-secondary program

Completed my Free Application for Federal Student Aid (FAFSA)

Name of high school or organization that issued the student's GED: *

Month & Year of High School Graduation or GED Completion *

Please upload a copy of your high school diploma or GED certificate (a photo or scanned copy are acceptable). *

Student information

Student First And Last Name *

Street Address (number, street and apt or suite no.) *

City, State, and Zipcode (you must include all three for this entry to be valid) *

Phone Number *

Student Email Address *

Social Security Number

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Please check this box to verify you are completing this form for one individual. *

Individual/Sole Proprietor

What are your post-secondary plans (check all that apply)? *

Please list the name of the post-secondary program you will be attending: *

Please list your intended field of study or trade (or "undecided" if you are not sure):

How do you intend to use the children's savings account help pay for your post-secondary expenses? *Check all that apply *

Housing costs

Transportation costs (car/bus/bike/train/flights)

Book costs

Fees associated with your post-secondary program

Utilities expenses (electricity/water/gas)

Internet & technology (cell phone/laptop/wifi)

Other: Other:

Did you receive financial education since joining the Children's Savings Account program? *

Yes

No

Are you interested in serving as a mentor for other students in the Children's Savings Account program? *

Yes

No

Completion

I certify that the information I have provided above is accurate to the best of my knowledge. *Please note that it may take up to 60 days for THA to process your disbursement request once submitted. You will receive an email confirmation from the Children's Savings Account program specialist upon receiving your request. *

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Today's Date * +