Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Have you allocated tax contribution to another Scholarship Tuition Organization (STO) this calendar year? *

Yes

No, this is my first contribution to any STO this year.

Filing Status *

Filing Separately/ Single Tax Payer

Filing Jointly/ Married

Claiming Tax Credit For: *

2020

2021

A. Original Tax Credit or your actual tax liabilities, whichever is less *

Contribution Amount

$593- Filing single

$1,186 - Filing jointly / married

Other

Optional Student Recommendation

First Name

Last Name

B. Switcher Tax Credit

In order to contribute towards “B”, you must maximize your contribution to “A” for the same taxable year.

$590 - Filing single

$1,179 - Filing jointly / married

Other

Optional Student Recommendation

First Name

Last Name