GIVE TO ENABLE SUPPORT PROGRAM - APPLICATION

This Application must be completed and submitted (or printed, completed and mailed) to the Treasurer's Office by Monday, June 1, 2026. Applications postmarked or timestamped after this date will not be accepted. This form may only be used by a Qualified Individual who does not have an Enable Account (or an ABLE account in another state) at the time he or she is approved to become a participant in the Program. Please see the Give to Enable Support Program Rules (opens in a new tab) for more information.

Required fields are denoted with an asterisk.*

First Name*:

Last Name*:

Date of Birth*:

Address:

City:

State:

Zip:

Email Address*:

An Authorized Individual is a person or entity who can transact on an Enable Account on behalf of the Account Owner. The Authorized Individual may be the Account Owner’s agent under a power of attorney or, if none, a conservator or legal guardian, spouse, parent, sibling, grandparent of the Account Owner, or a representative payee appointed for the Account Owner by the Social Security Administration, in that order. The Account Owner maintains ownership of the money in the Account.

Authorized Individual First Name:

Authorized Individual Last Name:

Disclaimer*:

I understand that to be eligible for the Give to Enable Support Program, I must also be eligible for an Enable account and I do not currently have an Enable account (or an ABLE account in another state). I hereby certify that I am eligible for an Enable account and I do not have an Enable account (or an ABLE account in another state). (Enter your initials here.)

Release:

I grant my permission for my statement to be used, with or without my name and/or picture, in promotional materials for the Give to Enable Support Program. My statement may be used on websites, ads, social media, fliers, and at public events. I understand granting permission does not guarantee approval or funding. See the Support Program Rules (opens in a new tab) for additional information.