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2021-2022 Scholarship Application

Education Fund of Northern Nevada (EFNN) is a Nevada non-profit corporation which was formed by a group

of Nevada businessmen for the express purpose of soliciting donations and providing scholarships as authorized

under the provisions of the Nevada Educational Choice Scholarship Program (NECSP). The law governing the

NECSP allows businesses to contribute their Nevada Modified Business Tax to a qualified Scholarship Grant

Organization approved by the State of Nevada Department of Education. The Education Fund of Northern

Nevada is one of the Scholarship Grant Organizations in Nevada.

EFNN is also a qualified charitable organization pursuant to Section 501(c)(3) of the Internal Revenue Code

and as such, contributions made to EFNN are deductible for federal tax purposes as charitable contributions. All

businesses making contributions to EFNN should consult their individual accountants or other tax professionals

regarding the specific tax consequences of contributions to EFNN.

What makes Education Fund of Northern Nevada different is that the board of directors, administrators,

accountants, and office staff are all from Nevada. Our office is in Reno, Nevada and all our people are part of

the local and State community. We understand the need for private education in The State of Nevada.

EFNN Scholarship Criteria and Procedures

EFNN Scholarship grants will be made in accordance with Nevada state law and on the basis of objective and

nondiscriminatory criteria. The procedure through which scholarship recipients (“Students”) will be selected is

as follows:

1. EFNN’s scholarship committee will review completed scholarship applications received by

EFNN. An application for a scholarship grant is not considered completed until all information requested below

has been received by the scholarship committee.

2. The general criteria which will be considered by the Scholarship Committee in awarding

scholarships on an objective and nondiscriminatory basis will include, but will not necessarily be limited to, the

following:

a. financial need:

With respect to financial need, as required by Nevada law, scholarships will be awarded only to

individuals who are members of a household that has household income that is not more than three hundred

percent (300%) of the federally designated level signifying poverty. Please do not submit an application

unless you reasonably believe your household income is below the level that applies to you as EFNN

cannot award scholarships to students whose income is above the applicable level. For the 2021-2022

school year, the federally designated levels signifying poverty and the amount equal to 300% of each level are

as follows:

Household income is determined under the US Department of Agriculture’s Income Eligibility

Guidelines for qualification for free and reduced-priced meals and includes for all Household Members, the sum

of the following: (a) monetary compensation for services, including wages, salary, commissions or fees; (b) net

income from non-farm self-employment; (c) net income from farm self-employment; (d) Social Security; (e)

dividends or interest on savings bonds or income from estates or trusts; (f) net rental income; (g) public

assistance or welfare payments; (h) unemployment compensation; (i) government civilian employee or military

retirement, or pensions or veterans payments; (j) private pensions or annuities; (k) alimony or child support

payments; (l) regular contributions from persons not living in the household; (m) net royalties; and (n) other

cash income, such as amounts received or withdrawn from any source including savings, investments, trust

accounts and other resources. Household Member means anyone who is living with you and shares income and

expenses, even if not related.

The amount of each scholarship awarded to a Student for any fiscal year cannot exceed the maximum

amount authorized by Nevada law. For the 2020-2021 school year, this amount was $8,469. All scholarship

grants will be paid by EFNN directly to the Nevada school selected by the Student’s parent or guardian for

attendance.

3. EFNN may award scholarships for attendance at a high school or other qualified educational institution

on an annual basis. Each recipient must reapply each year. Only renewal applicants will be considered

presuming the recipient continues to satisfy all of the requirements of EFNN, Nevada state law and the

applicable Nevada school. EFNN intends to obtain reports from the Student’s school to determine the Student’s

performance at the school for which the scholarship grant was awarded.

Household Size

Federal Poverty

Guidelines

(Annual)

$12,880

$17,420

$21,960

$26,500

$31,040

$35,580

$40,120

$44,660

For each additional family member add

$4,540

300% of Federal

Poverty Guideline

Amount

$38,640

$52,260

$65,880

$79,500

$93,120

$106,740

$120,360

$133,980

Thank you for choosing to Education Fund of Northern Nevada to facilitate your “Nevad

a Choice”.

PLEASE RETURN THE COMPLETED APPLICATION TO:

Education Fund of Northern Nevada

Attn: Scholarship Committee

P.O. Box 10480

Reno, NV 89510

Applications

FOR RETURNING

HIGHSCHOOL STUDENTS

ONLY

must be received at the above

address by June 1st, 2021!

Applications will not be accepted in person or

via email

2021-2022

EFNN Scholarship Application

SCHOLARSHIP APPLICATION

1. REQUIRED DOCUMENTATION: All of the following must be provided for each Household

Member of the Student. PLEASE NOTE: IF THE STUDENT CURRENTLY QUALIFIES FOR

FREE OR REDUCED PRICE MEALS OR MILK, YOU MAY PROVIDE PROOF OF THAT

QUALIFICATION IN LIEU OF ANY OTHER DOCUMENTATION REQUESTED BELOW.

(a) A tax transcript for the 2020 federal income tax return that has been filed. This must be obtained

from the Internal Revenue Service via its website (irs.gov), or via phone.

(b) A copy of your 2020 Federal Form 1040 U.S. Individual Income Tax Return.

for Extension of Time to File U.S. Federal Income Tax Return. (Please note the application will be

considered incomplete until the return is submitted). Tax returns must be submitted before the

application deadline of June 1st 2021.

(d) Copies of all 2020 W-2 forms and Tax Statements.

(e) Copies of all 2020 Form 1099s.

(f) Copies of all supporting tax schedules if you have income/loss from any of the following as to

your most recently filed form 1040, 1040A or 1040-EZ that you are providing in response to item

(a), above:

a. Business - Send Schedule C and Form 4562 Depreciation and Amortization

b. Farm - Send Schedule F and Form 4562 Depreciation and Amortization

c. Rental Property - Send Schedule E

d. S-Corporation - Send Schedule E, Form 1120S, Schedule K-1 and Form 8825

e. Partnership - Send Schedule E Form 1065, Schedule K-1 and Form 8825

f. Estates and Trusts - Send Schedule E, Form 1041 and Schedule K-1

(g) Provide supporting documentation for each category of Non-Taxable Income listed in the Schedule

provided at Item III. in the attached Application Information Form.

(h) Transcript from the Student’s most recent high school.

NOTE: It is recommended to wait and send the application and all supporting documentation

together. Please send in a complete application before the deadline of June 1st 202

Date

Application Information FOR RETURNING STUDENTS ONLY

Name and Phone Number of School Student Desires

to Attend if Grant Awarded:

School:

Phone Number:

Name and Phone Number of Student's Current

School (if different than above):

School:

Phone Number:

I. STUDENT INFORMATION

Last Name First Name M.I.

Birth Date

Ethnicity Gender

Grade level in 2021-2022

Have you previously been awarded a scholarship

by Education Fund of Northern Nevada?

If yes, list year(s)

Street Address Line 2

State

Zip Code

Cell Phone Number

Street Address Line 2

State

Zip Code

II. PARENT/GUARDIAN AND HOUSEHOLD INFORMATION

First Name M.I.

Date of Birth (MM/DD/YYYY)

Last Name

Street Address Line 2

Student Current Residence Information

Street Address

City

Home Phone Number

Primary Residence Information

(if different from above)

Street Address

Yes

Does this student have a disability?

Yes

Email Address (optional)

City

Social Security Number

Primary Phone Number

City State Zip Code

Home Phone Number Cell Phone Number

E-Mail Address

Marital Status Relationship to Student

Occupation Employer

Religious Affiliation (optional)

Another Co-Applicant Parent or Guardian is living in my household.

Yes

Parent or Guardian Information - Co-Applicant

Last Name First Name M.I.

Social Security Number Date of Birth (DD/MM/YYYY)

Primary Phone Number Secondary Phone Number

E-Mail Address

Marital Status Relationship to Student

Occupation Employer

Religious Affiliation (optional)

Household Information

Number Household Members

(any person living with you and sharing income and expenses, even if not related)

Names of Household Members Relationship to Student

III. NON-TAXABLE INCOME

List total amounts (annually) for all household members listed above that is received for each type of non-

taxable income:

A. Child Support Received

B. Worker's Compensation

C. Social Security or Disability

Benefits not taxed

D. Welfare and/or Aid for Families

with Dependent Children (AFDC/ADC)

D. Temporary Assistance for Needy

Families (TANF)

E. Other Non-Taxable Income

IV. OTHER TUITION ASSISTANCE OR SUPPORT

List the Amounts of all other forms of Tuition or other Educational Support or Assistance the Student will

Receive or is Expected to Receive.

A. Financial Aid or Tuition Assistance from School Student

is Applying for Scholarship from EFNN to Attend:

B. Support from Friends/Relatives/Employers/Other Educational Grants, etc.

C. Funds to be Deposited Into an "Education savings account" for

the 2021-2022 School Year pursuant to SB 302 enacted by

the 2016 Session of the Nevada Legislature.

D. Funds from any other Nevada Choice Scholarship Grant Organization such as

EFNN.

V. EXPECTED CHANGES IN INCOME, IF ANY

Do you expect any material changes in income for 2021?

Yes

If Yes, please explain and provide the expected amount of the change, whether positive or negative.

The undersigned Applicant and Co-Applicant represent and warrant that the information provided in this

scholarship application is complete, true and correct in all material respects. I acknowledge and agree that

any failure to provide such complete, true and correct information is grounds for immediate revocation of any

scholarship awarded as a result of the information provided in this Application. In addition, I hereby

authorize any Nevada school receiving scholarship funds from EFNN for the Student named in this

application to receive any and all transcripts and/or other academic reports for the Student for any year as to

which such scholarship funds were provided. I also declare that I have contacted the current school and school

district my child is attending as to our intentions to transfer to a private school. All grants are subject to

availability of funds and regardless of the amount of any grant awarded by EFNN, actual grants shall not

exceed the amount required to fully fund the Student's 2021-2022 approved educational costs after giving

effect to all receipts of the types outlined in Section IV, above. All 2021-2022 school year scholarship

applications must be received by June 1st, 2021. Completed applications must be mailed to: Education

Fund of Northern Nevada, ATTN: Scholarship Committee, P.O. Box 10480, Reno, NV 89510.

Applications are not accepted in person or via e-mail.

Signature of Applicant Signature of Co-Applicant

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