First Name

Last Name

Phone Number

Email

Street

* Please include Apt # or PO Box if applicable

City

County

Adams County Alamosa County Arapahoe County Archuleta County Baca County Bent County Boulder County City & County of Broomfield Chaffee County Cheyenne County Clear Creek County Conejos County Costilla County Crowley County Custer County Delta County City and County of Denver Dolores County Douglas County Eagle County Elbert County El Paso County Fremont County Garfield County Gilpin County Grand County Gunnison County Hinsdale County Huerfano County Jackson County Jefferson County Kiowa County Kit Carson County La Plata County Lake County Larimer County Las Animas County Lincoln County Logan County Mesa County Mineral County Moffat County Montezuma County Montrose County Morgan County Otero County Ouray County Park County Phillips County Pitkin County Prowers County Pueblo County Rio Blanco County Rio Grande County Routt County Saguache County San Juan County San Miguel County Sedgwick County Summit County Teller County Washington County Weld County Yuma County Non Colorado County

State

Zip

Relationship to Child

Parent Legal Guardian Grandparent Relative/Other Family Member Friend

First Name

Last Name

Date Of Birth

Ethnicity

Prefer not to answer Asian Black/African American Hispanic, Latino/Latina, or Spanish origin (Any race) Native Hawaiian or Other Pacific Islander White/Caucasian Other American Indian, Alaskan Native or Native American

Gender

Female Male Prefer not to answer

Birth Certificate State File Number

* This number can be found on the Birth Certificate.

Birth     Adoption

CollegeInvest Account Number

Advisor Name

Advisor Firm

Advisor Phone

Advisor Email

Parent/Guardian Household Count

Dependent Household Count

Income

$0-9,999 $10,000-19,999 $20,000-29,999 $30,000-39,999 $40,000-49,999 $50,000-59,999 $60,000-74,999 $75,000-99,999 $100,000-199,999 $200,000-399,999 $400,000-999,999 $1,000,000+

Check here if this is your first CollegeInvest college savings account

By submitting this application, I attest that all information provided above is accurate to the best of my knowledge. I also understand that in the event it is revealed that I provided any false information, CollegeInvest shall immediately revoke any First Step Award.