Education Freedom Tax Credit · IRC § 25F

Legacy Scholarship Program

Scholarship Granting Organization Application · Academic Year 2026–2027

Student Information

Enter the applicant student's personal and contact details.

First Name *

Last Name *

Date of Birth *

Grade Level *

Gender

Home Address

Street Address *

City *

State *

ZIP Code *

Contact Information

Phone Number *

Student Email (if applicable)

Parent / Guardian

Provide details for the primary parent or legal guardian.

Primary Parent / Guardian

First Name *

Last Name *

Relationship *

Phone *

Email *

Employer (optional)

Second Parent / Guardian (optional)

First Name

Last Name

Relationship

Phone

Household & Finances

Used for eligibility determination. All information is kept strictly confidential.

Eligibility Note: The Education Freedom Tax Credit (IRC § 25F) prioritizes households at or below 300% of the Federal Poverty Level. Participation in qualifying federal or state assistance programs may satisfy income verification requirements.

Number of People in Household *

Total Annual Household Income *

Public Assistance Programs

Household receives SNAP benefits?

Yes No

Student enrolled in Medicaid or CHIP?

Yes No

Household receives SSI?

Yes No

Student in foster or kinship care?

Yes No

Academic Background

Tell us about the student's current educational setting and activities.

Current School Name *

Current School Type *

Academic Standing / GPA

Accepted to requested school already?

Yes No

Extracurricular Activities & Interests

Special Needs & Accommodations (Confidential)

Does the student have an IEP, 504 Plan, or documented special need?

This information is kept confidential and helps us match students to appropriate scholarship resources.

Yes No

Scholarship Request

Provide details about the school you're requesting funding for and your personal statement.

Requested School / Institution *

Application Status

Requested School Address

Annual Tuition Amount ($)

Total annual tuition as listed by the requested school

Scholarship Amount Requested ($) *

Amount you are requesting from this SGO

Personal Statement

Write in the student's or family's own voice. Reviewers look for genuine need and a clear educational goal — not polished prose.

Statement of Need — Why are you applying for this scholarship? *

0/300 words

Educational Goals — What do you hope to achieve?

0/200 words

Documents & Certification

Confirm which supporting documents you will submit, then sign the application.

Supporting Documents

Check each document you are enclosing. Missing documents may delay review and disbursement.

Proof of Household Income

Most recent tax return (1040), W-2s, or official income verification letter

Student Birth Certificate or Government ID

Copy of birth certificate, passport, or state-issued photo ID

Proof of Current Enrollment / Transcript

Current school enrollment verification and most recent report card or transcript

Acceptance Letter from Requested School

If not yet accepted, letter must be received before any funds are disbursed

IEP / 504 Plan (if applicable)

Current Individualized Education Program or Section 504 accommodation plan

Signature & Certification

Full Legal Name *

Relationship to Student *

Date *

I certify that I am the parent or legal guardian of the student named in this application (or the student if age 18 or older), and that I am authorized to submit this application on the student's behalf.I certify that all information provided in this application is true, complete, and accurate to the best of my knowledge. I understand that providing false or misleading information may result in disqualification and recovery of any scholarship funds disbursed.

Privacy Notice: Information collected on this application is used solely for scholarship eligibility determination and is protected under applicable federal and state privacy laws. Financial and personal information will not be shared with third parties except as required by law or scholarship program compliance obligations.

Fields marked * are required. Once submitted, you will receive a reference number — save it for your records.