Provider Login

Welcome

If you would like to become an approved provider on behalf of the FES (formerly Gardiner), please enter the requested information below.
Our staff will review your submission and provide a response via email with instructions to create your provider account.

indicates a required field.

Group Type

Provider Type:

Are you part of a group? You have more than one provider you are submitting for approval.

Provider Name:	*
License #:	* *
Expiration Date:	* *

Financial Institution Information

Account Type

Checking

Savings

Account Usage

Business

Personal

Account Name

Financial Institution

State

City

ACH Routing Number

* *

Account Number

* *

Confirm Account Number

* *

Provider Contact Information

Physical Street Address:

State:

City:

County:

Zip Code:

Do you have a mailing address that is different from your physical address?

Yes

Primary Contact:	*
Primary Contact Email Address:*	* * *
Confirm Email Address:	* *
Primary Contact Phone Number:	* *

Provider Tax Information

Tax ID Type:	*
Tax ID:	* *


Do you or your business have family, financial, or business relationships with Step Up For Students staff or board members or do you have a child currently on the FES (formerly Gardiner)?		*

*	I hereby authorize Step Up For Students to initiate credit entries to my account at the financial institution named above. This authority is to remain in full force and effect until SUFS has received written notification of its termination in such time and in such manner as to afford Step Up For Students and the financial institution a reasonable opportunity to act on it.
*	I hereby certify that the below statements are true and accurate: All information on this enrollment form is true and accurate. I understand that all invoices submitted for payment under this program must be for the educational benefit of the participating student. I understand that any amount invoiced to the student’s FES (formerly Gardiner) account should not be payable or reimbursable by an insurance or any other benefit plan. I will not share, refund, or rebate any funds from the FES (formerly Gardiner) account with the parent or participating student in any manner. The above authority is to remain in full force and effect until SUFS has received written notification of its termination in such time and in such manner as to afford SUFS and the financial institution named above a reasonable opportunity to act on it.
*	I have read and understand the policies and guidelines presented in the FES (formerly Gardiner) Scholarship Provider Handbook.


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