Arizona Department of Education

EMPOWERMENT SCHOLARSHIP ACCOUNT 2023-2024 CONTRACT

This Empowerment Scholarship Account Contract (“Contract”) is entered into the first day after the contract is fully
executed (“Effective Date”) by and between the Arizona Department of Education (“ADE”) and Jazmin Rivera
(“Holder”), referred to collectively as the Parties, pursuant to Arizona Revised Statutes (“A.R.S.”) § 15-2402(B).

In consideration of the mutual promises contained herein, and for valuable consideration, the receipt and sufficiency
of which are hereby acknowledged, and intending to be legally bound, the parties agree as follows:
1. Empowerment Scholarship Account. In exchange for Holder’s commitment to the obligations set forth
in Section 4 of this Contract, ADE will establish, for the 2023-2024school year, an Empowerment
Scholarship Account (“ESA”) to be used for the benefit of Aiden Rivera jimenez (“Student”). ADE shall
transfer funds to the Office of the Arizona State Treasurer (“Treasurer”) on a quarterly basis in the amount
of $8,642.43 (“ESA Funds”) to begin after the contract is fully executed by all Parties. The Treasurer will
deposit the ESA Funds each quarter into the ESA administered by the Treasurer or by a third party with
whom the Treasurer has contracted (“Third Party Vendor”).

2. Term. This Contract will be effective for the 2023-2024 school year or such portion of the school year
remaining (the Term) as of the Effective Date and is not retroactive. Unless earlier terminated pursuant to
the terms set forth in this Contract, or for any other reason at the sole discretion of ADE, this Contract will
terminate on June 30, 2024.

3. Termination Procedure.

A. If ADE determines Holder has violated the terms of this Contract or taken action that fails to comply
with the requirements of the ESA Program (see A.R.S. §15-2402), including but not limited to Holder
taking action perceived as misuse of ESA funds (see A.R.S. §15-2403(C)), ADE may suspend the account
of Holder, and notify Holder in writing that the account has been suspended (“Suspension Notice”) and
that no further transactions will be allowed, or disbursements made, until a resolution is reached.

B. The Suspension Notice will specify the reason for the suspension and give Holder notice that she/he has 15
business days to respond to the Suspension Notice and take corrective action.

C. If Holder fails to remedy the reason for suspension, the account may be terminated.

D. Contacting the Third Party Vendor directly in an effort to interfere with an ADE issued suspension will
be considered fraud, and result in immediate termination.

E. If fraud is suspected, Holder’s account(s) may remain suspended until the conclusion of the Office of
the Arizona Attorney General’s (“Attorney General”) investigation pursuant to A.R.S. §15-2403(F. Upon
the issuance of the Attorney General’s investigation findings, the account may be terminated.

F. If ADE terminates this Contract prior to the end of the Term, Holder forfeits all rights to any ESA Funds
in the account at the time of termination and may be required to reimburse previously expended ESA
Funds to the State of Arizona (“State”). Once terminated, ADE reserves the right, in its sole discretion, to
terminate all accounts for the Holder. Additionally, when terminated for suspected misuse and/or fraud,
Holder shall no longer be eligible to reapply for an ESA in the future.

G. Pursuant to A.R.S. §15-2403(D), a parent may appeal to the Arizona State Board of Education
(“SBE”), any ADE administrative decision to terminate the ESA account, according to the procedures
established by Arizona Administrative Code (“A.A.C.”) R7-2-1511.

4. Holder Representations and Obligations. Holder represents that he/she has read and understood the relevant
ESA statutes (A.R.S. §§15-2401 et seq.) and agrees to use the ESA Funds in compliance with the controlling
statutes and this Contract. To the extent that any legal requirement set forth in law changes during the Term, the
Holder shall comply with the revised legal requirements.

5. Using ESA Funds. Holder shall use funds in accordance with A.R.S. § 15-2402 and the current ESA Parent
Handbook.

6. Cash Withdrawal and Cash Withdrawal Attempts Prohibited. In order for ADE to ensure compliance with
A.R.S. §15-2402 during the Term, Holder agrees he/she will not attempt a cash withdrawal, or complete a
cash withdrawal, with the prepaid debit card, if issued to the Holder. Any attempt of a cash withdrawal and/or
cash withdrawal shall constitute a violation of this Contract and may result in the immediate termination of
this Contract.

7. Public School Enrollment. Pursuant to A.R.S. § 15-2402(B)(2), during the Term, Holder will not accept ESA
Funds while Student is enrolled in a public school. Enrollment of Student in a public school while receiving
ESA Funds during the Term constitutes a violation of this Contract and shall result in the immediate
termination of this Contract.

8. School Tuition Organization (STO) Scholarships. Pursuant to A.R.S. §15-2402(B)(3), during the Term,
Holder will not accept ESA Funds in the same contract year with receiving a scholarship grant for Student
from a School Tuition Organization (“STO”). Acceptance of a scholarship grant for Student from an STO
while receiving ESA Funds, during the Term, shall constitute a violation of this Contract and may result in the
immediate termination of this Contract.
9. Public School Services. Holder certifies that he/she releases the Student’s prior public school district or
charter school from all obligations to educate the qualified student. This paragraph does not relieve the school
district or charter school from the obligation to conduct an evaluation pursuant to section A.R.S. §15-766, 20
U.S.C. 1412(a)(3) and A.R.S. § 15-2402(B)(2)(a).

10. Misrepresentation of Information. Holder represents that all information provided to ADE in the ESA
application filed by Holder on behalf of Student is complete, accurate, and the most current information
available. If ADE determines that any of the information provided by Holder as part of the ESA application is
incorrect, ADE may, at its sole discretion, terminate this Contract.

11. Bank Requirements. Holder will provide additional information and/or sign agreements or waivers required
by any Third Party Vendor.

12. Fraudulent Activity. Holder acknowledges that if ADE obtains evidence of fraudulent use of ESA Funds, or
observes any substantial misuse of the ESA Funds, ADE may refer Holder to the SBE, who in turn may refer
Holder to the Attorney General for the purpose of collections or investigation pursuant to A.R.S. §15-2403
(F), which may result in criminal prosecution.

13. Referral to Collections. Holder acknowledges that he/she shall be required to repay any ESA Funds spent for
any expenditure other than those specifically set forth in A.R.S. §15-2402(B)(4). Any failure to repay such
funds may result in referral to the Attorney General for collection and/or criminal investigation.

14. Choice of Law. This Contract shall be governed by and construed in accordance with the laws of the State of
Arizona. Venue for any action to enforce this Contract shall be in Maricopa County, Arizona.

15. Waiver. ADE’s and/or SBE’s failure to strictly enforce any term of this Contract does not constitute a
waiver of such term or prevent ADE and/or SBE from strictly enforcing any term of this Contract at any time.

16. Conflict of Interest. This Contract is subject to cancellation under A.R.S. § 38-511.

17. Notices. Any required notice under this Contract shall be sent by either e-mail or mail to the party at the
address below, as requested by the Holder. The Parties agree to communicate with each other regarding all
matters in good faith and with civility.

Holder: Jazmin Rivera

526 W. Rio Salado Parkway #116
Mesa, AZ 85201
JazminRiveraJimenez@gmail.com

ADE: Arizona Department of Education

Empowerment Scholarship
Account 1535 West Jefferson St.,
Bin #41
Phoenix, Arizona 85007
ESA@azed.gov

18. Applicant Information Verification: I have verified the information below and declare it to be accurate.

Name Jazmin Rivera

Address 526 W. Rio Salado Parkway #116, Mesa, AZ 85201

Phone (602)733-2104

Email Address JazminRiveraJimenez@gmail.com

Parent/Guardian Date of Birth 07/01/1999

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JR

Initials of Parent/Guardian

If the above information is NOT accurate contact ESA immediately at 602-364-1969 so that a
corrected contract can be prepared for your signature. If your contact information changes during the Term of
this Contract, you have 10 days to update the portal.

19. Arbitration. To the extent required by A.R.S. § 12-1518, and after exhausting applicable administrative remedies,
both parties agree to resolve all disputes arising out of or relating to this Contract through arbitration.”

20. Compliance with Civil Rights Laws. It is understood that each of the parties shall comply with the provisions or
Arizona Executive Order 2009-9, Title VI of the Civil Rights Act of 1964, as amended, Section 504 of the
Rehabilitation Act of 1973, as amended, and the Americans with Disabilities Act, as amended.

21. Non-Availability of Funds. In accordance with A.R.S. § 35-154, every payment obligation of the State under the
Agreement is conditioned upon the availability of funds appropriated or allocated for payment of such obligation.
If funds are not allocated and available for the continuance of this Contract, this Contract may be terminated by
the State at the end of the period for which funds are available. No liability shall accrue to the State in the event
this provision is exercised, and the State shall not be obligated or liable for any future payments or for any
damages as a result of termination under this paragraph.

22. Entire Contract; Amendment. This Contract, the attachments and any ancillary documents set forth herein
constitute the entire agreement between the Parties concerning the subject matter hereof and supersedes all
previous agreements, written or oral, concerning the ESA. This Contract may be amended only by written
agreement duly executed by both Parties.
23. Bank Consent Form. 1. ESA FUNDS: I understand that all ESA Funds shall be used in accordance with the
permissible expenditures set forth in A.R.S. § 15-2402, A.A.C. R7-2-1507 and the ESA Contract between
myself and ADE.

MONITORING OF CARD TRANSACTIONS: I give permission to the Treasurer and any Third Party Vendor to
share with the State, including ADE, any and all information regarding any transaction made using ESA funds

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Initials of Parent/Guardian

24. Parent Handbook. The current ESA Parent Handbook is located at https://www.azed.gov/esa/parent-handbook/
and constitutes an ancillary part of this Contract.

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Initials of Parent/Guardian

IN WITNESS WHEREOF, ADE has caused this Contract to be executed by its duly authorized representative and
Holder has executed this Contract as of the Effective Date.

HOLDER ARIZONA DEPARTMENT OF EDUCATION

Signature: Jazmin Rivera Jimenez

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Jazmin Rivera Jimenez (Mar 24, 2024 08:52 PDT)

Email: jazminriverajimenez@gmail.com
Tom Horne
Superintendent of Public Instruction
Arizona Department of Education

Date 03/24/2024

140458
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Application ID