apply@arizonaleader.org
Fax: 855.340.9399
SCHOOL TUITION ORGANIZATION AWARD VERIFICATION
The applicant may be qualied 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 Tuion Organizaon:
The information below must be completed by the STO that made the award or the school that received
the award funds. Please aach the completed form to your applicaon and submit to the Arizona Lead-
ership Foundaon.
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 connued to be enrolled in a private school since receiving the award and the above informaon is
accurate.
______________________________________ ______________________________________ _____________
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.
