Authorized Representative Details

This page collects additional information about the authorized representative you have elected to assist in the application/LaCAP Enrollment process.

 

Some items have an asterisk (*) next to them, indicating they are mandatory. You must fill in these items before you can continue to the next page.

 

If you do not wish to name an Authorized Representative, click the Previous button to return to the previous page and choose No for the question “Would you like to have an Authorized Representative?”

 

Type the desired Authorized Representative’s first and last name in the text boxes. Be sure to use the full, legal name. Do not use nicknames on this application/LaCAP Enrollment. The First Name text box allows a maximum of 30 characters, and the Last Name text box allows a maximum of 30 characters. If the name does not fit in the boxes, type as much of the name as you can.

 

If you do not know the contact information for the individual you wish to name as an Authorized Representative, you may click the Save & Exit button to exit the online application and save your progress on your application. The application/LaCAP Enrollment is saved as Incomplete.

 

If the relationship of the applicant to the Authorized Representative is not listed in the relationship drop-down menu, select Related in another way.

 

Click the Print button to print this page for your reference.

 

Click the Next button to save and continue with the online application/LaCAP Enrollment.