2024-2025 OH ACE QESP APPLICATION

2024-2025 Qualified Education Service Provider Application
Ohio ACE Marketplace Pre-Application Questionnaire
My organization only sells physical goods (curriculum and materials) and does not provide any services.*

Yes (my organization only provides curriculum & materials)No (my organization provides services)
Does your program offer physical education activities?

YesNo
Does your program currently use other federal funds/grants in whole or part for the services you hope to provide in the program?
I confirm that my program

Does use other federal funds/grantsDoes not use other federal funds/grants
Are you a JPSN provider?

YesNo
Review the following before filling out your application:

Service Provider Requirements

Service Categories Explained

Qualified Education Service Provider (QESP) Application Requirements
Requirements Confirmation*

I confirm that I read and understand the Service Provider Requirements, QESP Application Requirements, and Service Categories Explained.

Information about you
You must be an Authorized Party by your Organization to complete this application form. Authorized Party means you are authorized to transact or authorize transactions for all business relating to any deposit account which transfers of funds may be made through Online Banking for the corporation, partnership, limited liability company or other business organization or a city, town, village, school district or other governmental body which you are representing on this application form.
Name of individual filling out application*

First NameLast Name
Phone Number of individual filling out application*
This will not be public, it will only be used to contact you about your registration.
Email of individual filling out application*
This will not be public, it will only be used to contact you about your registration. This email will receive email alerts when claims are waiting for your approval.
Your Role or Position at Organization*
Your Government-issued Photo ID (must not have blurred out sections)*

Please upload a copy or photo of a Government-issued Photo ID. Only the front side is needed, but your name must be legible and photo clearly identifiable.
Cancelof
Is your name on the business license?*

YesNo
Are you a sole proprietor?

YesNo
Employment Verification Letter (Required if your name is not on the business license)

This letter must be on a letterhead from your organization and contain all of the following: (1) organization name and (2) complete organization address, (3) current job title of the employee, (4) employment dates, along with the (5) explicit approval to act on behalf of the organization, and the (6) name, (7) signature and (8) contact details of the person who prepared the letter.
Cancelof

Ohio ACE Letter of Attestation for Education Service Provider Background Checks

Only sign below if the attestation is true!!!
Ohio ACE Letter of Attestation for Education Service Provider Background Checks

{dbaOrganization58}

To Whom It May Concern,

I, {nameOf}, hereby attest that all personnel associated with {organizationName} have completed current criminal background checks.

I confirm that the information provided in this attestation is true and accurate to the best of my knowledge.

Sincerely,

{nameOf}

{date188}

{yourRole37}

{organizationEmail}
Signature*

Clear
Only sign if all information in the attestation above is accurate
For more information on acceptable background checks and disqualifying offenses, visit this help center article.
Date

MonthDayYear
Date

Sign and Submit
Please verify that you are human*
I hereby attest that I am authorized to represent the Organization I am enrolling in the OHIO ACE program. I understand and agree to all the terms and conditions for participation in the OHIO ACE program and attest that all eligibility statements made herein are materially true and correct. If my organization is providing invoices for reimbursement, my ACH information must be linked with Merit to be reimbursed. I understand that failure to provide the committed educational services for verified purchases may result in removal from the program and will require the return of grant funds for that purchase. I further understand that fraud of any kind under this program constitutes interstate wire fraud and will be punished to the full extent of the law.

Additionally, any changes to my organization's services will be communicated to Merit within five business days. Merit reserves the right to edit a Qualified Service Providers Marketplace listing to provide clarification, eligibility information, requested changes, and errors.

By providing my phone number, I consent to receive text messages from Merit International, Inc. ("Merit") in relation to my participation in this program, program updates, and other pertinent messages about the Service. I acknowledge that Merit will be sharing my phone number with the ACE Ohio program to strictly be used in conjunction with the administration of this program. Text message opt-in is not a condition of participation in this program or using Merit's Service. I understand messaging and/or data charges may apply. Messaging frequency may vary. I understand that I can unsubscribe anytime by contacting help@gomerits.com or clicking the unsubscribe link (where available).
Signature*

Clear
By submitting this form you agree to our terms of service and privacy policy.
utm_source
utm_medium
utm_campaign
PM-GS-AO
Should be Empty:

2024-2025 Qualified Education Service Provider Application

Ohio ACE Marketplace Pre-Application Questionnaire

Review the following before filling out your application:

Information about you

Information about your Organization

Organization Listing

Ohio ACE Letter of Attestation for Education Service Provider Background Checks

Sign and Submit