Qualified Educational Service Provider Appeal Form
Your Name
*
First Name
Last Name
Your Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your Email Address
*
example@example.com
Your Organization Name
*
This must match what was entered on the original application being appealed!
Your Organization's Name as Shown on Business License
Is your organization in the state of Ohio?
Yes
No
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Is your organization only providing services virtually?
*
Yes
No
Is your organization already providing these services to students in Ohio?
*
Yes
No
Services Applied For - cannot appeal services that weren't originally applied for*
*
Before - or after - school educational programs
Day camps, including camps for academics, music, and arts
Tuition at learning extension centers
Tuition for learning pods
Educational, learning, or study skills services
Field trips to historical landmarks, museums, science centers, and theaters, including admission, exhibit, and program fees
Language classes
Instrument lessons
Tutoring
Business Type
*
Non-Profit / Tax Exempt
Sole Proprietor
Corporation
LLC
Community School
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Why you believe your application should be reconsidered
*
Please upload any/all supporting documentation that relates to your organization, the services you would like to provide and how it aligns with the Ohio Department of Education's guidelines.
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