Fax: 855.340.9399
The applicant may be qualied to receive a Corporate Tax Credit Scholarship if they previously received a scholarship from the
original individual income tax credit program or the switcher individual tax credit program or the corporate low-income tax
credit program and the child continued to attend a qualified Arizona private school in subsequent years.
I / We give the school or school tuition organization listed below permission to release scholarship information
and history regarding my child to the Arizona Leadership Foundation.
______________________________________ ______________________________________ _____________
Printed Name of Parent/Guardian Signature Date
Student Name:
Name of School where award was sent:
Name of School Tuion Organizaon:
The information below must be completed by the STO that made the award or the school that received
the award funds. Please aach the completed form to your applicaon and submit to the Arizona Lead-
ership Foundaon.
Please check one:
A scholarship was awarded under the ORIGINAL INDIVIDUAL tax credit program
A scholarship was awarded under the SWITCHER INDIVIDUAL tax credit program
A scholarship was awarded under the LOW-INCOME CORPORATE tax credit program
Date of the previous year School Tuition Organization scholarship award:
To my knowledge the student has connued to be enrolled in a private school since receiving the award and the above informaon is
______________________________________ ______________________________________ _____________
Name & Title Signature Date
A school tuition organization cannot award, restrict or remove scholarships solely on the basis of donor recommendation.
A taxpayer may not claim a tax credit if the taxpayer agrees to swap donations with another taxpayer to benefit either taxpayer’s own dependent.
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