ASF Tax Credit Request Form

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Your information

Education Tax Credit Form - Individual

Complete this form to allow ASF to submit your application to the GA Dept. of Revenue for a tax credit.

Choose your Filing Status *

Individual - Up to $2,500

Taxpayer Information

First Name *

Middle Name *

Last Name *

SSN *

Street *

Street2

City *

State *

Zip *

Email *

Verify Email *

Cell Phone *

Contribution Information

Contribution Amount *

I would like my contribution to be... *

Designated to a particular school or schools.

Undesignated (The ASF Board of Directors will select deserving school(s) or student(s).

Designated School(s)

I authorize the Alyn Scholarship Fund to submit our application through the GA Dept. of Revenue for an Education Tax Credit. I pledge to donate the amount indicated above and agree to fully fund my contribution within sixty (60) days of approval from the GA Dept. of Revenue.

Confirm Authorization *

Yes

Please type your full name in as a digital signature *

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