DCYF Form 15-370 "Education and Training Voucher (Etv) Program Payment Request" - Washington

What Is DCYF Form 15-370?

This is a legal form that was released by the Washington State Department of Children, Youth, and Families - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2020;
  • The latest edition provided by the Washington State Department of Children, Youth, and Families;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of DCYF Form 15-370 by clicking the link below or browse more documents and templates provided by the Washington State Department of Children, Youth, and Families.

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Download DCYF Form 15-370 "Education and Training Voucher (Etv) Program Payment Request" - Washington

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IMPORTANT REMINDERS
Education and Training Voucher (ETV)
• Original receipts are only required for personal items. Please mail
Program Payment Request
those receipts and completed form to:
DCYF
DATE OF REQUEST
TOTAL AMOUNT REQUESTED
ETV Program
$
PO Box 40983
NAME (FIRST AND LAST)
Olympia, WA 98501
• ALL other receipts can be sent via email if preferred.
MAILING ADDRESS
CITY
STATE ZIP CODE
• Type or write neatly.
• Remember to sign and date the form.
• Payments / Reimbursements may take 7-10 business days or
TELEPHONE NUMBER
CELL PHONE NUMBER
E-MAIL ADDRESS
longer.
Expenses
What expenses do you need help with?
Who does this payment get paid to?
Total Expenses
(Computer / Printer, Books, Supplies, etc.)
(Name and Mailing Address)
$
$
$
$
$
$
Amazon Orders: By signing and submitting this form, I give my consent for DCYF
By signing and submitting this form, you agree the requested funds
to provide my name, address, and the list of items on this form to Amazon, so they
will be used for the purposes stated on this form.
may be shipped directly to my residence. In doing so, I understand that I am
authorizing DCYF to share otherwise confidential information, which may indicate
that I am in foster care, for this purpose.
STUDENT’S SIGNATURE
DATE
STUDENT’S SIGNATURE
DATE
ETV STAFF’S SIGNATURE
DATE
ETV PROGRAM PAYMENT REQUEST
DCYF 15-370 (REV. 12/2020)
IMPORTANT REMINDERS
Education and Training Voucher (ETV)
• Original receipts are only required for personal items. Please mail
Program Payment Request
those receipts and completed form to:
DCYF
DATE OF REQUEST
TOTAL AMOUNT REQUESTED
ETV Program
$
PO Box 40983
NAME (FIRST AND LAST)
Olympia, WA 98501
• ALL other receipts can be sent via email if preferred.
MAILING ADDRESS
CITY
STATE ZIP CODE
• Type or write neatly.
• Remember to sign and date the form.
• Payments / Reimbursements may take 7-10 business days or
TELEPHONE NUMBER
CELL PHONE NUMBER
E-MAIL ADDRESS
longer.
Expenses
What expenses do you need help with?
Who does this payment get paid to?
Total Expenses
(Computer / Printer, Books, Supplies, etc.)
(Name and Mailing Address)
$
$
$
$
$
$
Amazon Orders: By signing and submitting this form, I give my consent for DCYF
By signing and submitting this form, you agree the requested funds
to provide my name, address, and the list of items on this form to Amazon, so they
will be used for the purposes stated on this form.
may be shipped directly to my residence. In doing so, I understand that I am
authorizing DCYF to share otherwise confidential information, which may indicate
that I am in foster care, for this purpose.
STUDENT’S SIGNATURE
DATE
STUDENT’S SIGNATURE
DATE
ETV STAFF’S SIGNATURE
DATE
ETV PROGRAM PAYMENT REQUEST
DCYF 15-370 (REV. 12/2020)