CORP Verification Form - Private School Tuition Fund 123

This information must be completed by the School Tuition Organization (STO), other than PSTF123, from which your child received the scholarship.

To be eligible for the Switcher Tax Credit Tuition Awards your child must have:

1. Received a scholarship from corporate donations in a prior school year for low-income students or from corporate donations for displaced/disabled students OR received an individual tax credit Switcher tuition award, AND

2. Continued to be enrolled in a qualified Arizona private school since receiving that scholarship.

Student Name*
First Middle Last
School Tuition Organization (STO)*
School Name of Awarded Student*
To the best of our STO Knowledge, since receiving this award, this Student has been enrolled in a private school.*
- Yes
Tax Credit Award Type*
- Corporate Tax Credit for Low Income Scholarships
- Corporate Tax Credit for Disabled- Displaced Scholarships
- Individual Tax Credit for Switcher Scholarships

Corporate Tax Credit for Low Income Scholarships

Date of Most Recent Award	Date of Award from a Prior School Year (if applicable)

Corporate Tax Credit for Disabled- Displaced Scholarships

Date of Most Recent Award	Date of Award from a Prior School Year (if applicable)

Individual Tax Credit for Switcher Scholarships

Date of Most Recent Award	Date of Award from a Prior School Year (if applicable)

Completed By (Name)*
Completed By (Title)*
Signature of STO Representative:*
Date*
MM slash DD slash YYYY
NOTE: A school tuition organization cannot award, restrict, or reserve scholarships only on the basis of a donor’s 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. A.R.S. 43-1603 (C). Any designation of your own dependent as a potential recipient is prohibited.