Alyn Scholarship Fund


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 *
Verification Process

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Education Tax Credit Form - Individual