Scholarships for Education Choice - Covenant Christian High School

Page 1

Covenant Christian High School and Scholarships for Education Choice have partnered together to offer eligible families a scholarship opportunity for their children. Scholarships for Education Choice (an initiative of Sagamore Institute) is an Indiana Department of Education certified organization authorized to participate in the state's School Scholarship Tax Credit Program. In order for the student to be considered for a scholarship, the application below must be completed and submitted. (NOTE: Since the donated funds are coming from a designated account for Covenant Christian High School, the school will set the scholarship amount according to school policies.)

A student enrolled at Covenant Christian High School is eligible to receive an Indiana Tax Credit Scholarship if:

They are a resident of Indiana, and
They are between the ages of 4 and 21, and enrolled in grades Pre-K-12. Students must turn 4 and be less than 22 by August 1, and
They come from a household with a total annual income within the guidelines below. Income is determined by the adjusted gross income on the 1040 filed for the taxable year immediately preceding the date of application.

Chart

If you believe that you or your child would qualify for this scholarship, then we encourage you to proceed and apply by selecting "Next" below. If you have multiple children in the same household applying for the scholarship, you will need to complete separate applications for each child.

Other questions? Please contact your school.

Academic Year for Scholarship

Page 2

Student Information

Legal First Name

Legal Last Name

Street Address

City

State

Zip / Postal Code

Birthdate

The student's birth date must be between 8/1/2003 and 8/1/2020 in order to qualify for a tax credit scholarship.

Grade

What grade will the student be in for the academic period for which you are applying?

Parent / Guardian Information

First Name

Last Name

Street Address (If different than student's)

City

State

Zip / Postal Code

Phone

Household Information

Household's Annual Income

This is the combined and verifiable adjusted gross income for everyone in the household from the most recent tax return(s).

# of Individuals in Household

What impact has the opportunity to choose private education had on your student or family? (NOTE: this question is not required and the response will not impact scholarship eligibility.)

School Information - FOR SCHOOL USE ONLY

Tuition Amount

Scholarship Award Amount

Is this student currently receiving a Choice Scholarship?

YesNo

Choice Award Amount

1040 - Please upload a copy of the most recent 1040. We are looking for just the pages that have the address, list of dependents, and AGI.

School Verification Initials

Page 3

Electronic Signature

Your initials and date of submission indicate that all of the information on this application is accurate and verifiable. By submitting this application you are providing consent to Scholarships for Education Choice to work with Covenant Christian High School to ensure that you meet the state of Indiana's eligibility requirements to receive a tax credit scholarship.

Submitted by a school administrator with permission from the familyParent/Guardian

Initials of person completing the form:

Today's Date

Contact Information