Career Scholarship Account (CSA) Provider Application

For the 2023-2024 academic year, only employers, intermediaries, or institutions who provide a joint program of Career and Technical Education (CTE), modern youth apprenticeship (as defined in IC 20-51.4-2-9.5 ), registered apprenticeship (as defined in IC 20-43-8-0.3 ), or the Indiana College Core may apply to be CSA Providers.

3. Name of your organization. *This question is required.

4. Name of your organization's program. *This question is required.

5. What pathway(s)/program(s) do you offer? *This question is required.

1) Pathway/Program
2) Pathway/Program
3) Pathway/Program
4) Pathway/Program
5) Pathway/Program

6. What certificate(s)/credential(s) will be earned as a result of your program? *This question is required.

1) Certificate/Credential
2) Certificate/Credential
3) Certificate/Credential
4) Certificate/Credential
5) Certificate/Credential

7. What was your program's cost per student for the 2022-2023 academic year? *This question is required.

8. What is your program's cost per student for the 2023-2024 academic year? *This question is required.

9. Provide a breakdown of the cost for the 2023-2024 academic year.
(If one or more of the options below are not applicable to your program, please input "NA" *This question is required.

Space Cell	Cost
Tuition	Tuition: Cost
Books	Books: Cost
Fees	Fees: Cost
Lab Equipment	Lab Equipment: Cost
Transportation	Transportation: Cost
Other	Other: Cost

10. If you included a cost above for "Other", define what this includes.

11. What is the length of your program? *This question is required.

12. Provide your first and last name. *This question is required.

13. Provide your email address. *This question is required. This question requires a valid email address.

14. Provide your organization's mailing address. *This question is required.

15. Provide your organization's city. *This question is required.

16. Provide your organization's zip code. *This question is required.

17. Provide the first and last name of your organization's point of contact. *This question is required.

18. Provide the email address of your organization's point of contact. *This question is required. This question requires a valid email address.

19. Provide the phone number of your organization's point of contact. *This question is required.

20. With which high school(s) are you partnering?
(Select between one and ten schools) *This question is required.

1) School
2) School
3) School
4) School
5) School
6) School
7) School
8) School
9) School
10) School

21. Are you an approved vendor with the state? *This question is required.

22. Approved providers will be required to provide student enrollment, program outcomes, and other data as requested to the Indiana Commission for Higher Education, Indiana Department of Education, and the Treasurer of State. *This question is required.

I agree to provide student enrollment, program outcomes, and other data needed to effectively administer the CSA Program to the Indiana Commission for Higher Education, Indiana Department of Education, and the Treasurer of State.