This request page is intended for Oklahoma Successful Adulthood (formerly Independent Living) Eligible youth only. If you have questions about your eligibility, please contact us at oksa@ou.edu or 1-800-397-2945.

* 1. What is your client ID? (Contact your worker if you don't know what your Client ID is. If your client ID is entered incorrectly we will e-mail you back. We cannot process your funds until we have a correct client ID.)

* 2. What is your first name?

* 3. What is your last initial?

* 4. What is your date of birth?

What is your date of birth?
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* 5. What is your e-mail address? (If you do not have an e-mail address create one or talk to your worker about a funds request.)

* 6. What is your phone number?

* 7. Which best describes your custody type?

* 8. Who should the check be made out to? (Who is the vendor? Check's cannot be made out to individuals without permission. Contact us at oksa@ou.edu if your check needs to be made out to an individual.)

* 9. What is the address of the business (or person) we are making the check out to? (We do not make checks out to youth for purchases.)

* 10. Where would you like us to send the check? (We do not send checks to vendors. This needs to be your address or to the address of someone you trust.)

* 11. What are you going to buy? (Be specific and estimate the cost for each item/service. Be specific with size, color, number, and description.)

Example: 1 Graduation Cap- blue, 1 Graduation Gown- blue, 1 White and blue Graduation Cap tassel, etc.

* 12. How will this request support your independent living plan? (Provide an explanation as a step for your plan.)

Example: I am requesting a tutor because I want to raise my chemistry grade from a C to an A.

Example: I am requesting a pair of steel toe boots because they will support my goal to have employment as a welder.

* 13. Total cost of item requested with tax. (Please note if the item you're requesting ends up costing less than the check by more than 5% you will need to buy a money order with the change and send it back to the check writer. Items must be $25 or or more.)

* 14. I understand that this request will go to my worker for final approval.

* 15. I understand that I MUST send a copy of the receipt for the item I am purchasing to the following email address or fax number after my purchase. Email receipts to payroll-oksa@acumen2.net or fax receipts to 877-364-2837.
If I do not send a receipt in I will not be able to request any more funds until I have submitted the receipt or paid back the amount I requested. (Please make a copy of the receipt OR take a picture of it and saveit on your phone in case it is lost.)

* 16. I understand that my check will arrive by mail within 10 to 15 business days of my worker approving my request, NOT the date that I am submitting it.

* 17. I understand that reimbursements require prior approval.  Email reimbursement receipts to OKSA@ou.edu.

* 18. Questions or comments. Click "Done" at the bottom of this survey to submit your request.

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