Fill - Free fillable form for each school must be attached).: Arizona PDF form

Arizona Public School Enrollment Verification (2020-21)

If a student qualifies to receive a Corporate or PLUS Tax Credit Scholarship by the following eligibility requirement,

“The student must have been enrolled in an Arizona public school K-12 as a full-time student for at least 90 days

of the prior fiscal year (or the equivalent of one full semester for that school), & then transferred to a qualified private

school.”

Then, this information is to be completed by the public school. Depending on the student’s current enrollment status,

you may need to provide information for both the current school year and the prior school year. If the student

attended more than one public school during a school year, provide information for all public schools (a separate

form for each school must be attached).

Student Name:

Name of Public School and District:

First day of school year (mm/dd/yy):

Last day of school year (mm/dd/yy):

Student’s Dates of Enrollment for School Year:

Grade:

Student was enrolled for one full semester of the school year. Yes No

If NO, student was enrolled for _______ days of the school year.

Name and Title of Individual Completing Form:

Signature and Date: