TCLISSP Online Application

Please fill out the following information, and move to the next step

Applying Student's First Name: Applying Student's Last Name:
Date of Birth:

City:

Private School Being Applied to:

Scholarship Granting Organization:

School District Assigned to Applying Student:

School Assigned to Applying Student:

Last Grade Level Completed by Applying Student:

Gender of Applying Student:

Race of Applying Student:

Hispanic Ethnicity:

Legal Address of Applying Student:

Address Line Two:

City:

State:

ZIP Code:
Parent/Guardian First Name:

Parent/Guardian Last Name:

Parent/Guardian Relationship to Applying Student:

Parent/Guardian Phone Number:

Parent/Guardian Email:

Household Economic Survey

Tax Credit For Low Income Students Scholarship Program

This form is to verify the income eligibility of a student for the Tax Credit for Low Income Students Scholarship Program

There are: people in my household, including all children and adults

Please enter only numbers

The total annual income... is:

Please enter only numbers

Consent For Disclosure

Sharing Information with Other Programs

Dear Parent/Guardian: You are consenting to have your data shared with the Student Granting Organization named in your application and the Kansas State Department of Education. If you do not sign this Consent For Disclosure form, your child will not be eligible for the Tax Credit Low Income Students Scholarship Program.

Verify and Complete Application

By clicking submit on this page I am agreeing to authorize the Kansas State Department of Education to release necessary information to the Scholarship Granting Organizations that partner with KSDE as a part of the Tax Credit for Low Income Students Scholarship Program in order to determine eligibility for the students applying for the program. This information may come from federally-protected sources of information such as the student’s educational records which are protected by the Family Educational Rights and Privacy Act (FERPA) and other sensitive data such as eligibility based on income. By clicking submit I also certify that I am a parent or legal guardian of the student applying and have the legal right to authorize the Kansas State Department of Education to release the given information. I voluntarily assume full responsibility for any reasonable risks associated with disclosing such information and agree to hold the Kansas State Department of Education and its employees harmless for any and all claims, injuries, damages, losses or suits arising out of such disclosure for any acts taken within the person or person’s scope of work as a state agency employee. I understand that any misrepresentation of facts by me or on my behalf may result in the denial of the application for this program Please check the checkbox

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(785) 296-3201

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The Kansas State Department of Education does not discriminate on the basis of race, color, religion, national origin, sex, disability, or age in its programs and activities. For more information, visit our grievance procedure page.

To accommodate people with disabilities, on request, auxiliary aides and services will be provided and reasonable modifications to policies and programs will be made. To request accommodations or for more information please contact the Office of General Counsel at gc@ksde.gov or by (785) 296-3201.

TCLISSP Online Application

Application Submitted!

Please fill out the following information, and move to the next step

Kansas leads the world in the success of each student.

Contact KSDE

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